解放军医学院学报Issue(4)：313-317,5.DOI:10.3969/j.issn.2095-5227.2015.04.004
验前概率联合冠脉CT造影对于稳定型冠心病的诊断价值
Diagnostic accuracy of pre-test probability combined with computed tomographic coronary angiography in patients suspected for stable coronary artery disease
摘要
Abstract
Objective To compare the performance of updated Diamond–Forrester method (UDFM) and Duke clinical score (DCS) in patients with stable angina pectoris and assess the combined application of pre-test probability and computed tomographic coronary angiography (CTCA) in these patients. MethodsFive hundred and twenty-three symptomatic patients who underwent both CTCA and conventional coronary angiography (CCA) in 2 weeks in Chinese PLA General Hospital from January 2012 to December 2013 were enrolled in this study. The pre-test probability was determined using UDFM and DCS for each patient. Receiver operating characteristics (ROC) curves were used to compare two models. The diagnostic accuracy of CTCA for detecting coronary artery disease (CAD) was compared with CCA. The estimated post-test probability was calculated by Bayesian statistics.Results Of the 523 patients, 385 (74%) were positive tested by CCA. Compared with UDFM, DCS reclassified more positive patients into high group (46% for DCSvs. 23% for UDFM,P<0.000 1). The areas under ROC curves (AUC) for DCS was significantly greater than that for UDFM [0.77 (0.73, 0.82) vs 0.71 (0.66, 0.77), P=0.000 9]. In patient-based evaluation by CTCA, three pre-test probability groups according to DCS revealed a sensitivity of 94%, 98% and 97%, a specificity of 94%, 87% and 55%, a positive predictive value (PPV) of 91%, 94% and 93%, and a negative predictive value (NPV) of 96%, 96% and 77%, respectively. The estimated post-test probabilities corresponded well with the observed one, especially for the intermediate estimated pre-test probability group (positive: 94.7%vs 93.6%, negative: 3.7%vs 4.0%).Conclusion Compared with UDFM, DCS has a better performance in calculating pre-test probabilities in patients with stable angina pectoris. In addition, the combined application of DCS and CTCA can avoid unnecessary tests.关键词
冠心病/冠脉CT造影/验前概率/贝叶斯定理Key words
coronary disease/coronary computed tomographic angiography/pre-test probability/Bayesian theorem分类
医药卫生引用本文复制引用
周伽,杨俊杰,周迎,杨晓波,张华巍,陈韵岱..验前概率联合冠脉CT造影对于稳定型冠心病的诊断价值[J].解放军医学院学报,2015,(4):313-317,5.基金项目
北京市科委首都临床特色应用研究(Z141107002514103) Supported by the Study on the Application of Capital, Clinical Characteri-stics(Z141107002514103) （Z141107002514103）
