{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,29]],"date-time":"2026-03-29T08:29:03Z","timestamp":1774772943968,"version":"3.50.1"},"reference-count":33,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100007405","name":"Danish Heart Foundation","doi-asserted-by":"publisher","award":["15-R99-A5837-22920"],"award-info":[{"award-number":["15-R99-A5837-22920"]}],"id":[{"id":"10.13039\/100007405","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010983","name":"Health Research Fund of Central Denmark Region","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010983","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002739","name":"Aarhus University Research foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002739","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL098237"],"award-info":[{"award-number":["R01HL098237"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL098236"],"award-info":[{"award-number":["R01HL098236"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL098305"],"award-info":[{"award-number":["R01HL098305"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R01HL098235"],"award-info":[{"award-number":["R01HL098235"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Models predicting the likelihood of obstructive coronary artery disease (CAD) on invasive coronary angiography exist. However, as stable patients with new-onset chest pain frequently have lower clinical likelihood and preferably undergo index testing by non-invasive tests such as coronary computed tomography angiography (CCTA), clinical likelihood models calibrated against observed obstructive CAD at CCTA are warranted. The aim was to develop CCTA-calibrated risk-factor- and coronary artery calcium score-weighted clinical likelihood models (i.e. RF-CLCCTA and CACS-CLCCTA models, respectively).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Based on age, sex, symptoms, and cardiovascular risk factors, an advanced machine learning algorithm utilized a training cohort (n = 38 269) of symptomatic outpatients with suspected obstructive CAD to develop both a RF-CLCCTA model and a CACS-CLCCTA model to predict observed obstructive CAD on CCTA. The models were validated in several cohorts (n = 28 340) and compared with a currently endorsed basic pre-test probability (Basic PTP) model. For both the training and pooled validation cohorts, observed obstructive CAD at CCTA was defined as &amp;gt;50% diameter stenosis. Observed obstructive CAD at CCTA was present in 6443 (22.7%) patients in the pooled validation cohort. While the Basic PTP underestimated the prevalence of observed obstructive CAD at CCTA, the RF-CLCCTA and CACS-CLCCTA models showed superior calibration. Compared with the Basic PTP model, the RF-CLCCTA and CACS-CLCCTA models showed superior discrimination (area under the receiver operating curves 0.71 [95% confidence interval (CI) 0.70\u20130.72] vs. 0.74 (95% CI 0.73\u20130.75) and 0.87 (95% CI 0.86\u20130.87), P &amp;lt; 0.001 for both comparisons).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>CCTA-calibrated clinical likelihood models improve calibration and discrimination of observed obstructive CAD at CCTA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjci\/jeaf049","type":"journal-article","created":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T20:23:06Z","timestamp":1738873386000},"page":"802-813","source":"Crossref","is-referenced-by-count":3,"title":["Clinical likelihood models calibrated against observed obstructive coronary artery disease on computed tomography angiography"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2790-2608","authenticated-orcid":false,"given":"Laust D","family":"Rasmussen","sequence":"first","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital , Hospitalsparken 15, DK-7400 Herning ,","place":["Denmark"]},{"name":"Department of Cardiology, Aalborg University Hospital , 9000 Aalborg ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0917-634X","authenticated-orcid":false,"given":"Samuel Emil","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Health Science and Technology, Aalborg University ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juhani","family":"Knuuti","sequence":"additional","affiliation":[{"name":"Turku PET Centre, Turku University Hospital and University of Turku , Turku ,","place":["Finland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jon","family":"Spiro","sequence":"additional","affiliation":[{"name":"Royal Perth Hospital, University of Western Australia ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adil","family":"Rajwani","sequence":"additional","affiliation":[{"name":"Royal Perth Hospital, Curtin University ,","place":["Australia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1536-7855","authenticated-orcid":false,"given":"Pedro M","family":"Lopes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental , Carnaxide, Lisbon ,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Rita","family":"Lima","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental , Carnaxide, Lisbon ,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1623-7382","authenticated-orcid":false,"given":"Ant\u00f3nio M","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Hospital Santa Cruz, Centro Hospitalar Lisboa Ocidental , Carnaxide, Lisbon ,","place":["Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teemu","family":"Maaniitty","sequence":"additional","affiliation":[{"name":"Turku PET Centre, Turku University Hospital and University of Turku , Turku ,","place":["Finland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antti","family":"Saraste","sequence":"additional","affiliation":[{"name":"Turku PET Centre, Turku University Hospital and University of Turku , Turku ,","place":["Finland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Newby","sequence":"additional","affiliation":[{"name":"British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh , Edinburgh ,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9876-4049","authenticated-orcid":false,"given":"Pamela S","family":"Douglas","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2116-2370","authenticated-orcid":false,"given":"Morten","family":"B\u00f8ttcher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital , Hospitalsparken 15, DK-7400 Herning ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lohendran","family":"Baskaran","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National Heart Centre Singapore , Singapore ,","place":["Singapore"]},{"name":"Duke-NUS Medical School, National University of Singapore , Singapore ,","place":["Singapore"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Winther","sequence":"additional","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital , Hospitalsparken 15, DK-7400 Herning ,","place":["Denmark"]},{"name":"Department of Clinical Medicine, Aarhus University , Aarhus ,","place":["Denmark"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"key":"2025043022555612700_jeaf049-B1","first-page":"e368","article-title":"2021 AHA\/ACC\/ASE\/CHEST\/SAEM\/SCCT\/SCMR guideline for the evaluation and diagnosis 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