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Forschungsdatenbank PMU-SQQUID

Ruling out coronary artery disease in primary care: development and validation of a simple prediction rule.
Bösner, S; Haasenritter, J; Becker, A; Karatolios, K; Vaucher, P; Gencer, B; Herzig, L; Heinzel-Gutenbrunner, M; Schaefer, JR; Abu Hani, M; Keller, H; Sönnichsen, AC; Baum, E; Donner-Banzhoff, N;
CAN MED ASSOC J. 2010; 182(12): 1295-1300.
Originalarbeiten (Zeitschrift)

PMU-Autor/inn/en

Sönnichsen Andreas

Abstract

Background: Chest pain can be caused by various conditions, with life-threatening cardiac disease being of greatest concern. Prediction scores to rule out coronary artery disease have been developed for use in emergency settings. We developed and validated a simple prediction rule for use in primary care. Methods: We conducted a cross-sectional diagnostic study in 74 primary care practices in Germany. Primary care physicians recruited all consecutive patients who presented with chest pain (n = 1249) and recorded symptoms and findings for each patient (derivation cohort). An independent expert panel reviewed follow-up data obtained at six weeks and six months on symptoms, investigations, hospital admissions and medications to determine the presence or absence of coronary artery disease. Adjusted odds ratios of relevant variables were used to develop a prediction rule. We calculated measures of diagnostic accuracy for different cut-off values for the prediction scores using data derived from another prospective primary care study (validation cohort). Results: The prediction rule contained five determinants (age/sex, known vascular disease, patient assumes pain is of cardiac origin, pain is worse during exercise, and pain is not reproducible by palpation), with the score ranging from 0 to 5 points. The area under the curve (receiver operating characteristic curve) was 0.87 (95% confidence interval [CI] 0.83-0.91) for the derivation cohort and 0.90 (95% CI 0.87-0.93) for the validation cohort. The best overall discrimination was with a cut-off value of 3 (positive result 3-5 points; negative result = 2 points), which had a sensitivity of 87.1% (95% CI 79.9%-94.2%) and a specificity of 80.8% (77.6%-83.9%). Interpretation: The prediction rule for coronary artery disease in primary care proved to be robust in the validation cohort. It can help to rule out coronary artery disease in patients presenting with chest pain in primary care.


Useful keywords (using NLM MeSH Indexing)

Adolescent

Age Factors

Aged

Aged, 80 and over

Chest Pain/diagnosis

Chest Pain/etiology

Child

Confidence Intervals

Coronary Artery Disease/complications

Coronary Artery Disease/diagnosis*

Cross-Sectional Studies

Female

Germany

Humans

Logistic Models

Male

Middle Aged

Odds Ratio

Predictive Value of Tests

Primary Health Care/methods*

ROC Curve

Risk Factors

Sensitivity and Specificity

Severity of Illness Index

Sex Factors

Young Adult