Coronary Artery Disease: Likelihood Ratios

Introduction: See UpToDate page http://www.utdol.com/online/content/topic.do?topicKey=chd/59850 for good prevalence data and discussion. "Investigators from Duke confirmed that age, gender, and chest pain symptoms were the most powerful predictors of CHD, but showed that other characteristics also increase the probability of CHD. These included diabetes mellitus, which was the strongest predictor, smoking, hypercholesterolemia, and Q waves or ST-T changes on the resting ECG."

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Tags: Cardiac Problem Vascular Tag this Diagnosis.

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Rate of CAD by age, gender, and type of chest pain	0%	http://www.utdol.com/online/content/topic.do?topicKey=chd/59850 (combined data from Diamond, GA, Forrester, JS, N Engl J Med 1979; 300:1350; and from Weiner, DA, Ryan, TJ, McCabe, CH, et al, N Engl J Med 1979; 301:230.)
Men with typical angina	89%	http://www.utdol.com/online/content/topic.do?topicKey=chd/59850 (from the Coronary Artery Surgery Study)
Women with typical angina	63%	http://www.utdol.com/online/content/topic.do?topicKey=chd/59850 (from the Coronary Artery Surgery Study)
More, Edit...

The likelihood ratios of findings for Coronary Artery Disease are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Good Positive and Negative Likelihood Ratios
Finding	Result	+LR	-LR
[ + ] Cardiac CT	+ 0 -	7.7	0
meta-analysis Study: Ann Int Med vol. 152 no. 3 167-177 (2010) http://www.annals.org/content/152/3/167.abstract?etoc
[ + ] PET/CT scan	+ 0 -	5.1	0.1
Study: Ann Intern Med 1999 May 4;130(9):719-28. PMID 10357690 (cited in UpToDate article)
[ + ] Nuclear Perfusion	+ 0 -	3.8	0.2
SPECT Study: Ann Intern Med 1999 May 4;130(9):719-28. PMID 10357690 (cited in UpToDate article)
[ + ] Cardiac MRI	+ 0 -	2.9	0.2
meta-analysis Study: Ann Int Med vol. 152 no. 3 167-177 (2010) http://www.annals.org/content/152/3/167.abstract?etoc
[ + ] Cardiac CT	+ 0 -	26.7	0.2
Sensitivity is for >75% stenosis, but specificity is for >50% stenosis (!). There is a lot of controversy surrounding this technique, especially as in imparts a great amount of radiation and is diagnostically limited in patients with significant coronary artery calcification. I believe this study is representative, but see UpToDate for more. Study: J Am Coll Cardiol 2005 Jul 5;46(1):147-54. PMID 15992649 http://www.utdol.com/online/content/topic.do?topicKey=noninvas/16702#5
[ + ] Stress Echocardiography	+ 0 -	6.3	0.3
Study: Ann Intern Med 1999 May 4;130(9):719-28. PMID 10357690 (cited in UpToDate article)
[ + ] Nuclear Perfusion	+ 0 -	2.9	0.3
planar Thallium Study: Ann Intern Med 1999 May 4;130(9):719-28. PMID 10357690 (cited in UpToDate article)
[ + ] Exercise ECG	+ 0 -	3	0.4
Full table from UpToDate: (amount of ST depression, sensitivity, specificity) 0.5 mm 80 60 1.0 mm 60 90 2.0 mm 20 98 Study: Circulation 1989 Jul;80(1):87-98. PMID 2661056