Correction to: Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

The original version of this article, published on 19 March 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The names of the authors Philipp A. Kaufmann, Ronny Ralf Buechel and Bernhard A. Herzog were presented incorrectly.

Applicability and accuracy of pretest probability calculations implemented in the NICE clinical guideline for decision making about imaging in patients with chest pain of recent onset.

OBJECTIVES: To analyse the implementation, applicability and accuracy of the pretest probability calculation provided by NICE clinical guideline 95 for decision making about imaging in patients with chest pain of recent onset. METHODS: The definitions for pretest probability calculation in the original Duke clinical score and the NICE guideline were compared. We also calculated the agreement and disagreement in pretest probability and the resulting imaging and management groups based on individual patient data from the Collaborative Meta-Analysis of Cardiac CT (CoMe-CCT). RESULTS: 4,673 individual patient data from the CoMe-CCT Consortium were analysed. Major differences in definitions in the Duke clinical score and NICE guideline were found for the predictors age and number of risk factors. Pretest probability calculation using guideline criteria was only possible for 30.8 % (1,439/4,673) of patients despite availability of all required data due to ambiguity in guideline definitions for risk factors and age groups. Agreement regarding patient management groups was found in only 70 % (366/523) of patients in whom pretest probability calculation was possible according to both models. CONCLUSIONS: Our results suggest that pretest probability calculation for clinical decision making about cardiac imaging as implemented in the NICE clinical guideline for patients has relevant limitations. KEY POINTS: • Duke clinical score is not implemented correctly in NICE guideline 95. • Pretest probability assessment in NICE guideline 95 is impossible for most patients. • Improved clinical decision making requires accurate pretest probability calculation. • These refinements are essential for appropriate use of cardiac CT.

[Angiography with 64-channel CT upon suspicion of stable coronary disease]. / Angiografi med 64-kanalers CT ved mistenkt stabil koronarsykdom.

BACKGROUND: Invasive coronary angiography is the gold standard for diagnosing coronary artery disease. CT angiography (CTA) is a non-invasive alternative that is more available and less expensive. Previous Norwegian experience with 16-channel CT has been less successful than that reported from other countries. Improved image resolution has increased expectations of a better diagnostic accuracy, but a new local assessment of the method's usefulness is needed before routine usage is implemented. MATERIAL AND METHODS: Patients with suspected stabile coronary disease, referred to invasive coronary angiography, were first assessed with 64-channel CT angiography. Patients with atrial fibrillation or previous bypass operation were not included. All patients who fulfilled the eligibility criteria were included in the study (104), but 13 who had an Agatston calcium score > or = 800 and three for whom the examinations were technically unsuccessful were excluded; the study material therefore consisted of 88 patients. We assessed the method's ability (diagnostic accuracy) to detect diameter stenoses > or = 50% in coronary segments > or = 2 mm (without stent). RESULTS: When 4% non-interpretable segments were interpreted as positive (stenotic), the sensitivity was 97%, the specificity 78% and the positive and negative predictive values were 77 and 98% on a patient level. For 50 patients who did not have significant stenosis, CTA correctly identified 39, but overestimated the degree of stenosis in 11 patients. INTERPRETATION: 64-channel CTA is best at ruling out obstructive coronary artery disease in patients with intermediate risk of such disease. Few patients with significant lesions were missed due to false negative CTA evaluations, but false positive findings are a problem in low risk populations.

[Mortality after acute coronary syndrome]. / Dødelighet etter akutt koronarsyndrom.

BACKGROUND: Acute coronary syndrome is one of the most frequent indications for hospitalization. Acute intervention has been increasingly emphasized during the last decade. Norwegian local hospitals have few follow-up data for this condition. MATERIAL AND METHODS: A cohort from a local hospital with a catchment area of 100,000 inhabitants was studied retrospectively and followed-up prospectively. Journals and ECG results were reviewed for all patients who were admitted locally or referred to PCI with the diagnosis acute coronary syndrome. The patients were classified as having either myocardial infarction with ST-elevation (STEMI), myocardial infarction without ST-elevation (NSTEMI), or unstable angina pectoris (UAP). Surviving patients were contacted for 6-month follow-up data. RESULTS: 206 patients with acute coronary syndrome were included (37% women). There were 43 patients (22%) with STEMI, 127 (62%) with NSTEMI and 32 (17%) with UAP. The mean age for onset of myocardial infarction was 67 years in the STEMI group and 76 years in the NSTEMI group. Six months mortality rate for the entire group was 17.5%, and rates for the subgroups were STEMI (14%), NSTEMI (23%) and UAP (3%). There were no deaths in the 15 patients with STEMI who underwent primary PCI < 12 hours after onset. INTERPRETATION: Mortality in acute coronary syndrome was higher in our study than for that reported in randomized trials, but comparable to recent reports on mortality in patients with NSTEMI.