Abstract 340: Improved Patterns for Advanced Non-Invasive Diagnostic Testing Using a Personalized Gene Expression Score among Patients Presenting to Primary Care Clinicians with Symptoms of Suspected Obstructive Coronary Artery Disease: Results from the IMPACT-PCP (Investigation of a Molecular Personalized Coronary Gene Expression Test on Primary Care Practice Pattern) Trial
Notice bibliographique
Résumé
Introduction: Chest pain is the chief complaint in ~10,000 visits/day in the primary care provider (PCP) office and results in approximately $5 billion/yr in testing costs. Better methods are needed to more accurately assess the CAD risk of patients (pts) in an office-based, non-invasive fashion and to optimize referrals to advanced non-invasive testing for further evaluation and care planning. Hypothesis: We hypothesized that gene expression score (GES) results would lead to a change in the PCP’s diagnostic evaluation of stable pts presenting in the ambulatory setting with symptoms suggestive of obstructive CAD. Methods: The IMPACT-PCP Trial was a multi-center, prospective study which enrolled 251 consecutive pts with no history of CAD seen by nine clinicians for evaluation of chest pain and related symptoms. All patients underwent GES testing: the clinician’s diagnostic strategy was evaluated before and after the GES result was known. The GES is a blood-based molecular diagnostic test with a 96% NPV for excluding the diagnosis of obstructive CAD (defined as at least one vessel with ≥50% coronary artery stenosis by quantitative coronary angiography or core-lab CT-angiography) in symptomatic patients. The primary outcome of interest was the decision change in the diagnostic testing pattern pre/post GES testing as measured by McNemar’s test and logistic regression modeling. Results: Characteristics of the 251 pts eligible for primary endpoint analysis included 140 (56%) women, mean age of 56.2 years (SD± 13.0), average BMI of 29.7 (SD± 6.7), and mean GES of 16 (SD± 10). Following GES, a decision change in treatment plan (e.g. MPI, CTA, and cardiac catheterization) was noted in 145 pts (58% observed vs 10% expected change, p<0.001). More patients had a decreased (n=93, 37%) versus increased (n=52, 21%) intensity of testing (p<0.001). In particular, among the 127 low GES pts (51% of study pts), 60% (76/127) had decreased testing and only 2% (3/127) had increased testing. Follow-up is ongoing, with 233 (93%) pts having completed 30-day follow-up. There has been one MACE event (stroke) reported. Conclusion: The GES was associated with a statistically significant and clinically relevant change in clinical decision making among pts evaluated for suspected symptomatic CAD. In conclusion, the addition of the GES showed clinical utility above and beyond conventional decision-making by optimizing the pt’s diagnostic evaluation, particularly around the reduction in the intensity of diagnostic testing among low GES patients.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».