International application of a new probability algorithm for the diagnosis of coronary artery disease

Robert Detrano, A. Jánosi, Walter Steinbrunn, Matthias Pfisterer, Johann Jakob Schmid, Sarbjit Sandhu, Kern H. Guppy, Stella Lee, Victor Froelicher

Research output: Contribution to journalArticle

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Abstract

A new discriminant function model for estimating probabilities of angiographic coronary disease was tested for reliability and clinical utility in 3 patient test groups. This model, derived from the clinical and noninvasive test results of 303 patients under-going angiography at the Cleveland Clink in Cleveland, Ohio, was applied to a group of 425 patients undergoing angiography at the Hungarian Institute of Cardiology in Budapest, Hungary (disease prevalence 38%); 200 patients undergoing angiography at the Veterans Administration Medical Center in Long Beach, California (disease prevalence 75%); and 143 such patients from the University Hospitals in Zurich and Basel, Switzerland (disease prevalence 84%). The probabilities that resulted from the application of the Cleveland algorithm were compared with those derived by applying a Bayesian algorithm derived from published medical studies called CADENZA to the same 3 patient test groups. Both algorithms overpredicted the probability of disease at the Hungarian and American centers. Overprediction was more pronounced with the use of CADENZA (average overestimation 16 vs 10% and 11 vs 5%, p <0.001). In the Swiss group, the discriminant function underestimated (by 7%) and CADENZA slightly overestimated (by 2%) disease probability. Clinical utility, assessed as the percentage of patients correctly classified, was modestly superior for the new discriminant function as compared with CADENZA in the Hungarian group and similar in the American and Swiss groups. It was concluded that coronary disease probabilities derived from discriminant functions are reliable and clinically useful when applied to patients with chest pain syndromes and intermediate disease prevalence.

Original languageEnglish
Pages (from-to)304-310
Number of pages7
JournalThe American journal of cardiology
Volume64
Issue number5
DOIs
Publication statusPublished - Aug 1 1989

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Coronary Artery Disease
Angiography
Coronary Disease
United States Department of Veterans Affairs
Hungary
Cardiology
Chest Pain
Switzerland

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

International application of a new probability algorithm for the diagnosis of coronary artery disease. / Detrano, Robert; Jánosi, A.; Steinbrunn, Walter; Pfisterer, Matthias; Schmid, Johann Jakob; Sandhu, Sarbjit; Guppy, Kern H.; Lee, Stella; Froelicher, Victor.

In: The American journal of cardiology, Vol. 64, No. 5, 01.08.1989, p. 304-310.

Research output: Contribution to journalArticle

Detrano, R, Jánosi, A, Steinbrunn, W, Pfisterer, M, Schmid, JJ, Sandhu, S, Guppy, KH, Lee, S & Froelicher, V 1989, 'International application of a new probability algorithm for the diagnosis of coronary artery disease', The American journal of cardiology, vol. 64, no. 5, pp. 304-310. https://doi.org/10.1016/0002-9149(89)90524-9
Detrano, Robert ; Jánosi, A. ; Steinbrunn, Walter ; Pfisterer, Matthias ; Schmid, Johann Jakob ; Sandhu, Sarbjit ; Guppy, Kern H. ; Lee, Stella ; Froelicher, Victor. / International application of a new probability algorithm for the diagnosis of coronary artery disease. In: The American journal of cardiology. 1989 ; Vol. 64, No. 5. pp. 304-310.
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