Extract

Background: Clinical risk stratification of patients with symptoms suggestive of obstructive coronary artery disease (CAD) remains a challenge. The initial diagnostic test often turns out to be normal and requires substantial healthcare resources. However, current primary risk prediction model, Diamond-Forrester score (DF-score), are currently not validated in patients with low/intermediate risk.

Purpose: To investigate the ability of clinical risk factors and DF-score to predict patients with suspected hemodynamically obstructive CAD compared to coronary artery calcium score (CACS).

Methods: We included 1675 consecutive patients (male: 49% mean age 57±8 years) referred to coronary computed tomography angiography (CTA) with symptoms suggestive of CAD and a low-intermediate risk profile. A medical interview was conducted prior to coronary CTA to obtain clinical risk factors. All patients with suspected obstructive CAD by coronary CTA (>50% diameter stenosis) were subsequently investigated by invasive coronary angiography and fractional flow reserve measurements. Hemodynamically obstructive CAD was defined as FFR ≤0.80.

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