Diagnostic performance data of the clinical decision rules for coronary artery disease*
| First author, year | Type | AUC | Sensitivity, % | Specificity, % | PPV, % | NPV, % |
| Performance of decision | ||||||
| Gencer rule | ||||||
| Gencer et al,7 2010 | Derivation† | 0.95 (0.92–0.97) | 97.6 | 71.3 | 33.5 | 99.5 |
| External validation | 0.75 (0.72–0.80) | 86.8 | 41.5 | 20.4 | 94.8 | |
| Marburg Heart Score | ||||||
| Bösner et al,15 2010 | Derivation† | 0.87 (0.83–0.91) | 86.4 (78.5–91.7) | 75.2 (71.8–78.3) | 34.9 (29.3–40.9) | 97.3 (95.5–98.4) |
| External validation | 0.90 (0.87–0.93) | 87.1 (79.9–94.2) | 80.8 (77.6–83.9) | 39.6 (32.6–46.6) | 97.7 (96.4–99.1) | |
| Haasenritter et al,16 2012 | External validation | 0.84 (0.80–0.88) | 89.1 (81.1–94.0) | 63.5 (60.0–66.9) | 23.3 (19.2–28.0) | 97.9 (96.2–98.9) |
| Haasenritter et al,17 2015 | External validation | N/A | 91.4 (82.5–96.0) | 60.6 (56.3–64.8) | 24.2 (19.5–29.8) | 98.1 (95.9–99.1) |
| INTERCHEST‡ | ||||||
| Aerts et al,14 2017 | Derivation§ | 0.84 | N/A | N/A | N/A | N/A |
| Validation in study 1 | N/A | 88.2 (79.5–93.6) | 82.2 (78.7–85.2) | 43.0 (35.8–50.4) | 97.9 (96.1–98.9) | |
| Validation in study 2 | N/A | 82.0 (75.1–87.3) | 73.8 (70.9–76.4) | 34.7 (30.2–39.5) | 96.0 (94.3–97.2) | |
| Performance of decision rule versus clinical judgement | ||||||
| Marburg Heart Score¶ | ||||||
| Haasenritter et al,17 2015 | GP’s unaided clinical judgement | N/A | 82.9 (72.4–89.9) | 61.0 (56.7–65.2) | 22.7 (18.0–28.2) | 96.3 (93.6–97.9) |
| Marburg Heart Score (external validation) | N/A | 91.4 (82.5–96.0) | 60.6 (56.3–64.8) | 24.2 (19.5–29.8) | 98.1 (95.9–99.1) | |
| Marburg Heart Score as triage test** | N/A | 81.4 (70.8–88.8) | 72.6 (68.6–76.3) | 29.1 (23.2–35.8) | 96.6 (94.3–98.0) | |
| GP’s aided clinical judgement | N/A | 90.9 (72.2–97.5) | 66.8 (60.5–72.6) | 20.6 (13.8–29.7) | 98.7 (95.5–99.6) | |
*We calculated the sensitivity, specificity, PPV and NPV using two-by-two contingency tables. We used the lowest probability category as ‘test negative’.
†Internal validation by means of bootstrapping techniques was performed.
‡Derivation used pooled individual patient data from five studies. The INTERCHEST was applied to two of these five studies to measure its diagnostic performance. We referred to this as ‘validation in study 1 and 2’.
§Internal validation by using a threefold cross-validation approach.
¶The GP’s unaided clinical judgement was compared with: (1) the Marburg Heart Score; (2) using the Marburg Heart Score as triage test; (3) the GP’s clinical judgement aided by the Marburg Heart Score.
**Patients with definite Marburg Heart Score results were counted as negative (score ≤2 points) or positive (score ≥4 points). In patients with an intermediate score (three points), the final test result was determined by the GP’s unaided clinical judgement.
AUC, area under the receiver operating characteristic curve; N/A, not applicable; NPV, negative predictive value; PPV, positive predictive value.