Background: Substantial differences exist between different guideline-recommended pretest probability (PTP) models for the detection of obstructive coronary artery disease (CAD). This study was... Show moreBackground: Substantial differences exist between different guideline-recommended pretest probability (PTP) models for the detection of obstructive coronary artery disease (CAD). This study was performed to study the performance of the 2021 American Heart Association/American College of Cardiology (AHA/ACC) guideline-recommended PTP (AHA/ACC-PTP) model in assessing the likelihood of obstructive CAD compared with previously proposed models. Methods and Results: Symptomatic patients (N=50 561) referred for coronary computed tomography angiography were included. The reference standard was invasive coronary angiography with optional fractional flow reserve measurements. The AHA/ACC-PTP values based on sex and age were calculated and compared with the 2019 European Society of Cardiology guideline PTP values based on sex, age, and symptoms as well as the risk factor-weighted clinical likelihood values based on sex, age, symptoms, and risk factors. The AHA/ACC-PTP maximum values overestimated by a factor of 2.6 the actual prevalence of CAD. Compared with the AHA/ACC-PTP model (area under the receiver-operating curve, 71.5 [95% CI, 70.7-72.2]), inclusion of typicality of symptoms in the European Society of Cardiology guideline PTP improved discrimination of CAD (area under the receiver-operating curve, 75.5 [95% CI, 74.7-76.3]). Inclusion of both symptoms and risk factors in the risk factor-weighted clinical likelihood model further improved discrimination (area under the receiver-operating curve, 77.7 [95% CI, 77.0-78.5]). The proportion of patients classified as very low PTP was lower using the AHA/ACC-PTP (5%) compared with the European Society of Cardiology guideline PTP (19%) and the risk factor-weighted clinical likelihood (49%) models. Conclusions: The new AHA/ACC-PTP model overestimates the prevalence of obstructive CAD substantially if type of symptoms and risk factors are not taken into account. Inclusion of both symptoms and risk factors improves model performance and identifies more patients with very low likelihood of CAD in whom further testing can be deferred. Show less
Baiocchi, G.L.; Giacopuzzi, S.; Marrelli, D.; Reim, D.; Piessen, G.; Costa, P.M. da; ... ; Manzoni, G. de 2019
BackgroundPerioperative complications can affect outcomes after gastrectomy for cancer, with high mortality and morbidity rates ranging between 10 and 40%. The absence of a standardized system for... Show moreBackgroundPerioperative complications can affect outcomes after gastrectomy for cancer, with high mortality and morbidity rates ranging between 10 and 40%. The absence of a standardized system for recording complications generates wide variation in evaluating their impacts on outcomes and hinders proposals of quality-improvement projects. The aim of this study was to provide a list of defined gastrectomy complications approved through international consensus.MethodsThe Gastrectomy Complications Consensus Group consists of 34 European gastric cancer experts who are members of the International Gastric Cancer Association. A group meeting established the work plan for study implementation through Delphi surveys. A consensus was reached regarding a set of standardized methods to define gastrectomy complications.ResultsA standardized list of 27 defined complications (grouped into 3 intraoperative, 14 postoperative general, and 10 postoperative surgical complications) was created to provide a simple but accurate template for recording individual gastrectomy complications. A consensus was reached for both the list of complications that should be considered major adverse events after gastrectomy for cancer and their specific definitions. The study group also agreed that an assessment of each surgical case should be completed at patient discharge and 90days postoperatively using a Complication Recording Sheet.ConclusionThe list of defined complications (soon to be validated in an international multicenter study) and the ongoing development of an electronic datasheet app to record them provide the basic infrastructure to reach the ultimate goals of standardized international data collection, establishment of benchmark results, and fostering of quality-improvement projects. Show less
