Obstructive Coronary Artery Disease Improved Prediction by the COME-CCT Pretest Probability Calculator With Cardiac CT

Wieske V, Walther M, Mohamed M, Weickert B, Andrzejewski S, Dubourg B, Andreini D, Pontone G, Alkadhi H, Hausleiter J, Garcia MJ, Leschka S, Meijboom WB, Zimmermann E, Gerber B, Schoepf UJ, Shabestari AA, Nørgaard BL, Meijs MF, Sato A, Øvrehus KA, Diederichsen AC, Jenkins SM, Knuuti J, Hamdan A, Halvorsen BA, Mendoza Rodriguez V, Rochitte C, Rixe J, Wan YL, Langer C, Bettencourt N, Martuscelli E, Ghostine S, Buechel RR, Nikolaou K, Mickley H, Yang L, Zhang Z, Chen MY, Halon DA, Rief M, Sun K, Niinuma H, Marcus RP, Muraglia S, Jakamy R, Chow BJ, Kaufmann PA, Herzog BA, Tardif JC, Nomura C, Kofoed KF, Laissy JP, Arbab-Zadeh A, Kitagawa K, Laham R, Jinzaki M, Hoe J, Rybicki FJ, Scholte A, Paul N, Tan SY, Yoshioka K, Roehle R, Schuetz GM, Laule M, Newby DE, Achenbach S, Budoff M, Haase R, Dodd JD, Dewey M, Schlattmann P (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 4

Article Number: 102014

Journal Issue: 8

DOI: 10.1016/j.jacadv.2025.102014

Abstract

Background: Combining pretest probability (PTP) with computed tomography angiography (CTA) for diagnosing obstructive coronary artery disease (CAD) has not yet been determined. Objectives: The purpose of this study was to evaluate the accuracy of PTP calculation alone and with CTA for diagnosing CAD. Methods: A total of 65 prospective diagnostic accuracy studies of patients clinically referred to invasive coronary angiography with stable chest pain were included in this international collaborative individual patient data Collaborative Meta-Analysis of Cardiac CT (COME-CCT) meta-analysis. Mixed-effects logistic regression with a data set–specific random intercept for clustering was applied to 4 models: the traditional Diamond-Forrester models, a PTP model based on the COME-CCT data (termed COME-CCT-PTP calculator), a CTA alone model, and a combined COME-CCT-PTP with CTA model. Results: Individual patient data from 5,332 patients with clinically indicated invasive coronary angiography from 22 countries were included. The COME-CCT-PTP calculator was more accurate than the original Diamond-Forrester model (AUC: 0.68; 95% CI: 0.66-0.69 vs 0.63; 95% CI: 0.62-0.65). The COME-CCT-PTP with CTA model significantly improved accuracy compared with either model alone (AUC: 0.86; 95% CI: 0.85-0.87 vs 0.81; 95% CI: 0.80-0.82). The improved prediction was consistent in decision curve analysis with an increased net benefit for all chest pain subtypes and was almost equally seen in patients with typical or atypical angina (0.85; 95% CI: 0.84-0.86) and nonanginal or other chest discomfort (0.88; 95% CI: 0.86-0.89). Conclusions: Combining the COME-CCT-PTP calculator with CTA provides more accurate prediction than the PTP or CTA alone for the diagnosis of obstructive CAD, for all chest pain subtypes.

Authors with CRIS profile

Involved external institutions

Tel Aviv University Israel (IL) Hospital Israelita Albert Einstein Brazil (BR) Østfold Hospital Trust / Sykehuset Østfold Norway (NO) Rigshospitalet Denmark (DK) Centre Hospitalier de Gonesse France (FR) University of São Paulo / Universidade de São Paulo (USP) Brazil (BR) Johns Hopkins Hospital United States (USA) (US) Hospital Universitário de Mie Japan (JP) Kerckhoff-Klinik Germany (DE) Harvard University United States (USA) (US) Chang Gung University (CGU) / 長庚大學 Taiwan (TW) Keio University Hospital Japan (JP) Mount Elizabeth Medical Centre Singapore (SG) Centro Hospitalar Vila Nova de Gaia Portugal (PT) University of Cincinnati United States (USA) (US) Università degli Studi di Roma 'Tor Vergata' Italy (IT) Leiden University Medical Center Netherlands (NL) Western University Canada (CA) Hôpital Marie Lannelongue France (FR) National Heart Centre Singapore Singapore (SG) Universitätsspital Zürich (USZ) Switzerland (CH) Iwate Medical University Japan (JP) Universitätsklinikum Tübingen Germany (DE) Charité - Universitätsmedizin Berlin Germany (DE) Odense Universitetshospital (OUH) Denmark (DK) Beijing Anzhen Hospital China (CN) University of Edinburgh United Kingdom (GB) Carmel Medical Center Israel (IL) St Vincent's University Hospital Ireland (IE) Harbor–UCLA Medical Center United States (USA) (US) Friedrich-Schiller-Universität Jena Germany (DE) Ernst-Abbe-Hochschule Jena (FH/EAH Jena) / Ernst Abbe University of Applied Sciences Jena Germany (DE) Hospital Center University Rouen / Centre hospitalier universitaire de Rouen (CHU) France (FR) Centro Cardiologico Monzino (IRCCS) Italy (IT) Aarhus University Hospital / Aarhus Universitetshospital Denmark (DK) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) University of Tsukuba / 筑波大学 Japan (JP) St. Luke's International Hospital Japan (JP) Luzerner Kantonsspital (LUKS) Switzerland (CH) Ospedale Santa Chiara Italy (IT) Pitié-Salpêtrière University Hospital / Hôpital universitaire Pitié-Salpêtrière France (FR) University of Ottawa Canada (CA) Glasgow Royal Infirmary (GRI) United Kingdom (GB) Turku University Hospital / Turun yliopistollinen keskussairaala (TYKS) Finland (FI) Institut de Cardiologie de Montréal Canada (CA) Ludwig-Maximilians-Universität (LMU) Germany (DE) Albert Einstein College of Medicine United States (USA) (US) Erasmus University Medical Center (MC) Netherlands (NL) Cliniques universitaires Saint-Luc (CHU St-Luc) Belgium (BE) Medical University of South Carolina (MUSC) United States (USA) (US) Shahid Beheshti University of Medical Sciences Iran, Islamic Republic of (IR) National Heart, Lung, and Blood Institute (NHLBI) United States (USA) (US) Baotou Central Hospital China (CN)

How to cite

APA:

Wieske, V., Walther, M., Mohamed, M., Weickert, B., Andrzejewski, S., Dubourg, B.,... Schlattmann, P. (2025). Obstructive Coronary Artery Disease Improved Prediction by the COME-CCT Pretest Probability Calculator With Cardiac CT. JACC: Advances, 4(8). https://doi.org/10.1016/j.jacadv.2025.102014

MLA:

Wieske, Viktoria, et al. "Obstructive Coronary Artery Disease Improved Prediction by the COME-CCT Pretest Probability Calculator With Cardiac CT." JACC: Advances 4.8 (2025).

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