†These authors contributed equally.
Academic Editors: Brian Tomlinson and Takatoshi Kasai
Background: For women presenting with stable chest pain (SCP), the
appropriate risk assessment strategy to identify individuals unlikely to benefit
from further cardiovascular imaging testing (CIT) is debatable. Thus, the present
study intended to compare two risk assessment strategies in these individuals.
Methods: 2592 women with SCP who underwent coronary computed tomography
angiography (CCTA) were divided into low and high risk group according to 2016
National Institute of Health and Care Excellence guideline-determined strategy
(NICE strategy) and 2019 European Society of Cardiology guideline-determined
strategy (ESC strategy), respectively. The associations of coronary artery
disease (CAD), major adverse cardiovascular event (MACE) and other subsequent
clinical outcomes with risk groups and net reclassification improvement (NRI)
were evaluated to compare different strategies. Results: Both NICE
strategy which focused on symptom evaluation and ESC strategy which was based on
pretest probability (PTP) determined by ESC-PTP model and
coronary artery calcium score-weighted clinical likelihood (CACS-CL) model
classified a proportion (34.49% and 63.97%, respectively) of individuals into
the low risk group. Compared to NICE strategy, ESC strategy indicated stronger
associations between risk groups and obstructive CAD (odds ratio: 27.63 versus
3.57), MACE (hazard ratios: 4.24 versus 1.91), more intensive clinical management
as well as a positive NRI (27.71%, p