Morise et al derived a logistic prediction model for the probability of significant coronary artery disease in a patient. The model was adjusted for disease prevalence in the population. The authors are from the West Virginia University, Cedars-Sinai Medical Center, and the Long Beach VA Hospital.
Significant coronary artery disease was defined as the presence of 1 or more lesions in the coronary arteries with >= 50% occlusion on angiography
Components to model:
(1) pretest probability
(2) post-exercise test probability
Parameters for pretest probability:
(1) age
(2) gender
(3) chest pain symptoms
(4) smoking
(5) diabetes mellitus
(6) cholesterol
Parameter |
Finding |
Points |
age in years |
|
(age in years) |
gender |
male |
0 |
|
female |
1 |
chest pain symptoms |
no angina pain |
1 |
|
nonanginal pain |
2 |
|
atypical angina |
3 |
|
typical angina |
4 |
current smoking |
no |
0 |
|
yes |
1 |
diabetes mellitus |
no |
0 |
|
yes |
1 |
cholesterol in mg/dL |
|
(cholesterol) |
If cholesterol data is available:
X =
= (0.0894 * (age)) - (1.522 * (points for gender)) + (0.476 * (points for symptoms)) + (0.447 * (points for smoking)) + (0.631 * (points for diabetes)) + (0.004 * (serum cholesterol)) – 7.123
If cholesterol data is not available:
X =
= (0.101 * (age)) - (1.31 * (points for gender)) + (0.334 * (points for symptoms)) + (0.506 * (points for smoking)) + (0.439 * (points for diabetes)) – 6.14
pretest probability of significant coronary artery disease =
= 1 / (1 + EXP((-1)*X))
Parameters for post-exercise test probability
(1) pretest probability, as a decimal fraction from 0 to 1.0
(2) ST depression in mm
(3) ST slope
(4) peak heart rate in beats per minute
Parameter |
Finding |
Points |
pretest probability |
|
(pretest) |
ST depression in mm |
|
(mm) |
ST slope |
upsloping |
1 |
|
horizontal |
2 |
|
downsloping |
3 |
peak heart rate in beats/minute |
|
(rate) |
If exercise data is available:
Y =
= (4.28 * (pretest probability)) + (0.618 * (mm ST depression)) + (0.475 * (points for ST slope)) – (0.015 * (peak heart rate)) – 1.30
If exercise data is not available:
Y =
= (4.60 * (pretest probability)) – (0.013 * (peak heart rate)) – 0.319
post-exercise probability of significant coronary artery disease =
= 1 / (1 + EXP((-1)*Y))
Specialty: Cardiology, Sports Medicine & Rehabilitation
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