Publications [#197812] of Daniel B. Mark

Papers Published

1. WB Batchelor, DB Mark, JD Knight, CB Granger, PW Armstrong, RM Califf, ED Peterson, Development and validation of a simple model to predict severe coronary artery disease after myocardial infarction: potential impact on cardiac catheterization use in the United States and Canada., American heart journal, vol. 145 no. 2 (February, 2003), pp. 349-55, ISSN 1097-6744 [doi]
   (last updated on 2011/11/29)

   Abstract:
   BACKGROUND: Improved patient selection may optimize the efficiency of cardiac catheterization in both high- and low-rate regions. The purpose of this study was to develop and validate a clinical model for predicting high-risk coronary artery disease (CAD) after myocardial infarction (MI) and to examine the model's potential impact on the use rate of both US and Canadian catheterization practices. RESULTS: By the use of baseline clinical variables from 1122 patients in the angiographic substudy of the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-1) trial, we developed a model that was predictive of severe CAD (left main or triple-vessel disease). The final model, which included prior MI, age, sex, hyperlipidemia, and decreased left ventricular ejection fraction (C-index = 0.70), was externally validated in 781 patients in the GUSTO IIb trial. Although the probability of severe CAD predicted 5-year survival, the frequency of catheterization in both Canada and the United States bore no relationship to severe CAD risk in the GUSTO-1 trial. By use of the model, we estimated that as much as 15% of US catheterizations from both GUSTO-1 and GUSTO IIb might have been avoided, without significantly compromising the number of patients with severe CAD who were identified (sensitivity = 0.94). By applying the model to Canadian practices, an additional 30 cases of severe CAD might have been identified per every 1000 catheterizations performed, without increasing the catheterization rate. CONCLUSIONS: The likelihood of severe CAD after ST-elevation MI may be predicted from simple baseline clinical variables. The use of a severe CAD predictive model to guide patient selection might enhance the cost-effectiveness of both aggressive and conservative catheterization practices.

   Keywords:
   Analysis of Variance • Canada • Coronary Angiography • Coronary Disease • Coronary Stenosis • Female • Heart Catheterization • Humans • Logistic Models • Male • Middle Aged • Myocardial Infarction • Predictive Value of Tests • Probability • ROC Curve • Treatment Outcome • United States • diagnosis* • economics • pathology • radiography • therapy* • utilization*