{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T02:20:10Z","timestamp":1790734810247,"version":"4.1.0"},"reference-count":21,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T00:00:00Z","timestamp":1701820800000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2023,11,10]]},"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>The risk factor-weighted and coronary artery calcium score-weighted clinical likelihood (RF-CL and CACS-CL, respectively) models improve discrimination of patients with suspected obstructive coronary artery disease (CAD). However, external validation is warranted.<\/jats:p>\n                  <jats:p>Compared to the 2019 European Society of Cardiology pretest probability (ESC-PTP) model, the aims were (1) to validate the RF-CL and CACS-CL models for identification of obstructive CAD and revascularisation, and (2) to investigate prognosis by CL thresholds.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Stable de novo chest pain patients (n=1585) undergoing coronary CT angiography (CTA) were investigated. Obstructive CAD was defined as &gt;70% diameter stenosis in a major epicardial vessel on CTA. Decision of revascularisation within 120 days was based on onsite judgement. The endpoint was non-fatal myocardial infarction or cardiovascular death. The ESC-PTP was calculated based on age, sex and symptom typicality, the RF-CL additionally included number of risk factors, and the CACS-CL incorporated CACS to the RF-CL.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Obstructive CAD was present in 386\/1585 (24.4%) patients, and 91\/1585 (5.7%) patients underwent revascularisation. Both the RF-CL and CACS-CL classified more patients to very-low CL (&lt;5%) of obstructive CAD compared with the ESC-PTP model (41.4% and 52.2% vs 19.2%, p&lt;0.001). In very-low CL patients, obstructive CAD and revascularisation prevalences (\u22646%\u2009and &lt;1%) remained similar combined with low event risk during 5.0 years follow-up.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>In an external validation cohort, the novel RF-CL and CACS-CL models improve categorisation to a very-low CL group with preserved prevalences of obstructive CAD, revascularisation and favourable prognosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2023-002457","type":"journal-article","created":{"date-parts":[[2023,12,6]],"date-time":"2023-12-06T12:53:59Z","timestamp":1701867239000},"page":"e002457","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["External validation of novel clinical likelihood models to predict obstructive coronary artery disease and prognosis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2790-2608","authenticated-orcid":false,"given":"Laust Dupont","family":"Rasmussen","sequence":"first","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital, Herning, Denmark"},{"name":"Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3556-2428","authenticated-orcid":false,"given":"Michelle Claire","family":"Williams","sequence":"additional","affiliation":[{"name":"University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E","family":"Newby","sequence":"additional","affiliation":[{"name":"University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan N\u00f8rtoft","family":"Dahl","sequence":"additional","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital, Herning, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel Emil","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Health Science and Technology, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"B\u00f8ttcher","sequence":"additional","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital, Herning, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8872-3681","authenticated-orcid":false,"given":"Simon","family":"Winther","sequence":"additional","affiliation":[{"name":"Department of Cardiology, G\u00f8dstrup Hospital, Herning, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,12,6]]},"reference":[{"key":"2025081710172116000_10.2.e002457.1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz425"},{"key":"2025081710172116000_10.2.e002457.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001029"},{"key":"2025081710172116000_10.2.e002457.3","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy267"},{"key":"2025081710172116000_10.2.e002457.4","doi-asserted-by":"crossref","first-page":"2421","DOI":"10.1016\/j.jacc.2020.09.585","article-title":"Incorporating coronary calcification into pre-test assessment of the likelihood of coronary artery disease","volume":"76","author":"Winther","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025081710172116000_10.2.e002457.5","doi-asserted-by":"crossref","first-page":"e105","DOI":"10.1093\/eurjpc\/zwab036","article-title":"Coronary calcification improves the estimation for clinical likelihood of obstructive coronary artery disease and avoids unnecessary testing in patients with borderline pretest probability","volume":"29","author":"Zhou","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"2025081710172116000_10.2.e002457.6","doi-asserted-by":"crossref","first-page":"1965","DOI":"10.1016\/j.jacc.2022.08.805","article-title":"Coronary calcium scoring improves risk prediction in patients with suspected obstructive coronary artery disease","volume":"80","author":"Winther","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"2025081710172116000_10.2.e002457.7","article-title":"Global epidemiology of ischemic heart disease: results from the global burden of disease study","volume":"12","author":"Khan","year":"2020","journal-title":"Cureus"},{"key":"2025081710172116000_10.2.e002457.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60291-4"},{"key":"2025081710172116000_10.2.e002457.9","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1805971"},{"key":"2025081710172116000_10.2.e002457.10","doi-asserted-by":"crossref","unstructured":"Rasmussen LD , Schmidt SE , Knuuti J , et al . Exercise electrocardiography for pre-test assessment of the likelihood of coronary artery disease. Heart 2023:heartjnl-2023-322970. doi:10.1136\/heartjnl-2023-322970","DOI":"10.1136\/heartjnl-2023-322970"},{"key":"2025081710172116000_10.2.e002457.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e3485","article-title":"Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts","volume":"344","author":"Genders","year":"2012","journal-title":"BMJ"},{"key":"2025081710172116000_10.2.e002457.12","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1915922"},{"key":"2025081710172116000_10.2.e002457.13","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1916370"},{"key":"2025081710172116000_10.2.e002457.14","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jez058"},{"key":"2025081710172116000_10.2.e002457.15","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1093\/ehjci\/jey182","article-title":"Pretest probability for patients with suspected obstructive coronary artery disease: re-evaluating Diamond-Forrester for the contemporary era and clinical implications: insights from the PROMISE trial","volume":"20","author":"Foldyna","year":"2019","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2025081710172116000_10.2.e002457.16","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.039255"},{"key":"2025081710172116000_10.2.e002457.17","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1093\/eurheartj\/ehy806","article-title":"Prediction of obstructive coronary artery disease and prognosis in patients with suspected stable angina","volume":"40","author":"Reeh","year":"2019","journal-title":"Eur Heart J"},{"key":"2025081710172116000_10.2.e002457.18","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeaa197"},{"key":"2025081710172116000_10.2.e002457.19","doi-asserted-by":"crossref","unstructured":"Rasmussen LD , Albertsen LEB , Nissen L , et al . Diagnostic performance of clinical likelihood models of obstructive coronary artery disease to predict myocardial perfusion defects. Eur Heart J Cardiovasc Imaging 2023:jead135. doi:10.1093\/ehjci\/jead135","DOI":"10.1093\/ehjci\/jead135"},{"key":"2025081710172116000_10.2.e002457.20","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2009.169441"},{"key":"2025081710172116000_10.2.e002457.21","doi-asserted-by":"crossref","first-page":"E40","DOI":"10.1093\/eurheartj\/suaa057","article-title":"Myocardial infarction with non-obstructive coronary arteries: what is the prognosis?","volume":"22","author":"Niccoli","year":"2020","journal-title":"Eur Heart J Suppl"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2023-002457","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T17:17:31Z","timestamp":1755451051000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2023-002457"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":21,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,12,6]]},"published-print":{"date-parts":[[2023,12]]}},"alternative-id":["10.1136\/openhrt-2023-002457"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2023-002457","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]}}}