HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Eric Lim Ayyaz Ali Zain Khalpey Francis Wells John Pepper Neil Moat Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lim, E. Articles by Moat, N. Search for Related Content PubMed PubMed Citation Articles by Lim, E. Articles by Moat, N. Related Collections Valve disease

J Thorac Cardiovasc Surg 2005;129:1318-1321
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

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

^a Department of Cardiothoracic Surgery, Royal Brompton Hospital, London, United Kingdom
^b Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom
^c Department of Epidemiology and Public Health, Imperial College School of Medicine and Technology, London, United Kingdom.

Received for publication September 16, 2004; revisions received October 16, 2004; accepted for publication October 28, 2004.

^_* Address for reprints: Eric Lim, Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge CB3 8RE, United Kingdom. (Email: eric.lim{at}cvsnet.org).

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.