A validated simple model to predict coexistent coronary disease in patients undergoing mitral valve surgery

Eric Lim, Ayyaz Ali, Zain I Khalpey, Hutan Ashrafian, Christopher Jackson, Ziad Ali, Themis Chamageorgakis, Francis Wells, John Pepper, Anthony Desouza, Neil Moat

Research output: Contribution to journalArticle

Abstract

Objective: The primary limitation of the American Heart Association/American College of Cardiology guidelines is specificity. To improve the selection process, we proposed a simple additive model including age (1 point for every 5 years above 50), male sex (2 points), hypercholesterolemia (2 points), angina (3 points), and electrocardiographic evidence of ischemia (3 points). We recommend screening angiography at 3 or more points. This model was previously derived from 359 patients at Papworth Hospital. Methods: The validation cohort was a consecutive series of patients who underwent mitral valve surgery at the Royal Brompton Hospital. Preoperative coronary angiography reports were obtained, and coronary disease was defined as luminal narrowing of 50% in 2 or more views. Sensitivities and specificities were calculated for the American Heart Association/American College of Cardiology criteria, the simple additive model, and a logistic regression model. Receiver operating characteristic curves were used to validate accuracy and compare discrimination with logistic regression. Results: From 1998 through 2003, angiographic details were available for 342 (86%) of 396 patients who underwent mitral valve surgery. The sensitivity and specificity of the American Heart Association/American College of Cardiology guidelines were 100% and 5%, respectively; those of the simple additive model were 91% and 44%, respectively; and those of logistic regression were 93% and 41%, respectively. The receiver operating characteristic areas for the simple additive and logistic regression model were 0.78 (95% confidence interval, 0.73-0.84) and 0.80 (95% confidence interval, 0.74-0.85), respectively. Conclusions: This is the third independent cohort to highlight the poor specificity of the American Heart Association/American College of Cardiology guidelines. Although high sensitivity is achieved, the cost is the majority of patients requiring screening angiography. Our validated simple model improved the specificity and selection; however, this was achieved at the expense of decreased sensitivity.

Original languageEnglish (US)
Pages (from-to)1318-1321
Number of pages4
JournalJournal of Thoracic and Cardiovascular Surgery
Volume129
Issue number6
DOIs
StatePublished - Jun 2005
Externally publishedYes

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Mitral Valve
Coronary Disease
Logistic Models
Guidelines
ROC Curve
Angiography
Confidence Intervals
Sensitivity and Specificity
Hypercholesterolemia
Coronary Angiography
Ischemia
Costs and Cost Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

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A validated simple model to predict coexistent coronary disease in patients undergoing mitral valve surgery. / Lim, Eric; Ali, Ayyaz; Khalpey, Zain I; Ashrafian, Hutan; Jackson, Christopher; Ali, Ziad; Chamageorgakis, Themis; Wells, Francis; Pepper, John; Desouza, Anthony; Moat, Neil.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 129, No. 6, 06.2005, p. 1318-1321.

Research output: Contribution to journalArticle

Lim, E, Ali, A, Khalpey, ZI, Ashrafian, H, Jackson, C, Ali, Z, Chamageorgakis, T, Wells, F, Pepper, J, Desouza, A & Moat, N 2005, 'A validated simple model to predict coexistent coronary disease in patients undergoing mitral valve surgery', Journal of Thoracic and Cardiovascular Surgery, vol. 129, no. 6, pp. 1318-1321. https://doi.org/10.1016/j.jtcvs.2004.10.039
Lim, Eric ; Ali, Ayyaz ; Khalpey, Zain I ; Ashrafian, Hutan ; Jackson, Christopher ; Ali, Ziad ; Chamageorgakis, Themis ; Wells, Francis ; Pepper, John ; Desouza, Anthony ; Moat, Neil. / A validated simple model to predict coexistent coronary disease in patients undergoing mitral valve surgery. In: Journal of Thoracic and Cardiovascular Surgery. 2005 ; Vol. 129, No. 6. pp. 1318-1321.
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abstract = "Objective: The primary limitation of the American Heart Association/American College of Cardiology guidelines is specificity. To improve the selection process, we proposed a simple additive model including age (1 point for every 5 years above 50), male sex (2 points), hypercholesterolemia (2 points), angina (3 points), and electrocardiographic evidence of ischemia (3 points). We recommend screening angiography at 3 or more points. This model was previously derived from 359 patients at Papworth Hospital. Methods: The validation cohort was a consecutive series of patients who underwent mitral valve surgery at the Royal Brompton Hospital. Preoperative coronary angiography reports were obtained, and coronary disease was defined as luminal narrowing of 50{\%} in 2 or more views. Sensitivities and specificities were calculated for the American Heart Association/American College of Cardiology criteria, the simple additive model, and a logistic regression model. Receiver operating characteristic curves were used to validate accuracy and compare discrimination with logistic regression. Results: From 1998 through 2003, angiographic details were available for 342 (86{\%}) of 396 patients who underwent mitral valve surgery. The sensitivity and specificity of the American Heart Association/American College of Cardiology guidelines were 100{\%} and 5{\%}, respectively; those of the simple additive model were 91{\%} and 44{\%}, respectively; and those of logistic regression were 93{\%} and 41{\%}, respectively. The receiver operating characteristic areas for the simple additive and logistic regression model were 0.78 (95{\%} confidence interval, 0.73-0.84) and 0.80 (95{\%} confidence interval, 0.74-0.85), respectively. Conclusions: This is the third independent cohort to highlight the poor specificity of the American Heart Association/American College of Cardiology guidelines. Although high sensitivity is achieved, the cost is the majority of patients requiring screening angiography. Our validated simple model improved the specificity and selection; however, this was achieved at the expense of decreased sensitivity.",
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AU - Lim, Eric

AU - Ali, Ayyaz

AU - Khalpey, Zain I

AU - Ashrafian, Hutan

AU - Jackson, Christopher

AU - Ali, Ziad

AU - Chamageorgakis, Themis

AU - Wells, Francis

AU - Pepper, John

AU - Desouza, Anthony

AU - Moat, Neil

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N2 - Objective: The primary limitation of the American Heart Association/American College of Cardiology guidelines is specificity. To improve the selection process, we proposed a simple additive model including age (1 point for every 5 years above 50), male sex (2 points), hypercholesterolemia (2 points), angina (3 points), and electrocardiographic evidence of ischemia (3 points). We recommend screening angiography at 3 or more points. This model was previously derived from 359 patients at Papworth Hospital. Methods: The validation cohort was a consecutive series of patients who underwent mitral valve surgery at the Royal Brompton Hospital. Preoperative coronary angiography reports were obtained, and coronary disease was defined as luminal narrowing of 50% in 2 or more views. Sensitivities and specificities were calculated for the American Heart Association/American College of Cardiology criteria, the simple additive model, and a logistic regression model. Receiver operating characteristic curves were used to validate accuracy and compare discrimination with logistic regression. Results: From 1998 through 2003, angiographic details were available for 342 (86%) of 396 patients who underwent mitral valve surgery. The sensitivity and specificity of the American Heart Association/American College of Cardiology guidelines were 100% and 5%, respectively; those of the simple additive model were 91% and 44%, respectively; and those of logistic regression were 93% and 41%, respectively. The receiver operating characteristic areas for the simple additive and logistic regression model were 0.78 (95% confidence interval, 0.73-0.84) and 0.80 (95% confidence interval, 0.74-0.85), respectively. Conclusions: This is the third independent cohort to highlight the poor specificity of the American Heart Association/American College of Cardiology guidelines. Although high sensitivity is achieved, the cost is the majority of patients requiring screening angiography. Our validated simple model improved the specificity and selection; however, this was achieved at the expense of decreased sensitivity.

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