Trust us! Time to move on from pretest probability scores for stable chest pain

Over the past four decades the medical community has been searching for methods to accurately assess pretest probability (PTP) of angiographically significant coronary artery disease (CAD) in patients with chest pain to optimally guide testing according to Bayesian principles. In 1979, Diamond and Forrester (D-F)1 famously described an approach using only patient age, sex and angina typicality to estimate the PTP of a stenosis of at least 50% on invasive coronary angiography. Beautiful in its simplicity, the D-F approach was broadly endorsed in international guidelines and clinical practice for decades until it was proven to significantly overestimate CAD prevalence when applied to contemporary patient populations. This observation led to iterative discoveries of newer, reportedly better-calibrated PTP scores, with most continuing to rely solely on the same three variables included by Diamond and Forrester.2 The 2019 European Society of Cardiology (ESC) chronic coronary syndrome guideline and...
Source: Heart - Category: Cardiology Authors: Tags: Editorials Source Type: research