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

Eric Lim, Ayyaz Ali, Zain 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 1 2005

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Lim, E., Ali, A., Khalpey, Z., 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, 129(6), 1318-1321. https://doi.org/10.1016/j.jtcvs.2004.10.039