Tan Yahang, Wang Zhe, Xin Qian, Li Na, Liu Fang, Xu Qiaoyu, Chen Mulei
Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, 100020 Beijing, China.
Senior Department of Cardiology, The Sixth Medical Center of PLA General Hospital, 100048 Beijing, China.
Rev Cardiovasc Med. 2023 Apr 3;24(4):101. doi: 10.31083/j.rcm2404101. eCollection 2023 Apr.
Low-risk individuals are unlikely to benefit from noninvasive testing, and women tend to have a lower prevalence of coronary artery disease (CAD). This study compared the performance of two current guidelines that differ by sex to assess s a'q's't chest pain outpatients, including symptom-based (2016 National Institute for Health and Care Excellence, NICE) and risk-based strategies (2019 European Society of Cardiology, ESC).
A total of 542 outpatients referred for coronary computed tomography angiography (CCTA) at a single-centre were retrospectively included in this study. A risk assessment was calculated for each outpatient according to the two guidelines. Patients were classified into low and high-risk groups according to each strategy. The presence of coronary artery disease was the endpoint. Net reclassification improvement (NRI) was used to assess the performance of the two strategies.
The prevalence of CAD was 27%. The sensitivity, specificity, positive predictive value and negative predictive value for ESC and NICE were 90.4%, 54.3%, 42.2%, 93.9% and 78.8%, 35.6%, 31.1% and 82.0% respectively. Compare to NICE, the NRI for ESC were 30.32%. The ESC guidelines classified 55.56% of women and 28.14% of men into the low-risk group. The ESC guidelines had a higher predictive value for coronary artery disease compared to the NICE guidelines, with a positive NRI in men (15.55%) and women (34.46%) respectively.
The ESC guidelines offered a more accurate calculation of risk assessment than the NICE guidelines. Patient sex influenced applying the recent ESC guidelines, which would result in a significant decrease in inappropriate testing of women but an increase in appropriate noninvasive testing of men.
低风险个体不太可能从无创检测中获益，且女性冠心病（CAD）的患病率往往较低。本研究比较了当前两种因性别而异的指南评估急性胸痛门诊患者的性能，包括基于症状的策略（2016年英国国家卫生与临床优化研究所，NICE）和基于风险的策略（2019年欧洲心脏病学会，ESC）。
本研究回顾性纳入了在单一中心接受冠状动脉计算机断层扫描血管造影（CCTA）检查的542例门诊患者。根据这两种指南为每位门诊患者计算风险评估。根据每种策略将患者分为低风险和高风险组。以冠状动脉疾病的存在作为终点。使用净重新分类改善（NRI）来评估这两种策略的性能。
CAD的患病率为27%。ESC和NICE的敏感性、特异性、阳性预测值和阴性预测值分别为90.4%、54.3%、42.2%、93.9%和78.8%、35.6%、31.1%、82.0%。与NICE相比，ESC的NRI为30.32%。ESC指南将55.56%的女性和28.14%的男性归为低风险组。与NICE指南相比，ESC指南对冠状动脉疾病的预测价值更高，男性（15.55%）和女性（34.46%）的NRI均为正值。
ESC指南比NICE指南能更准确地计算风险评估。患者性别影响了近期ESC指南的应用，这将导致女性不适当检测显著减少，但男性适当的无创检测增加。
