Bayesian probability analysis: a prospective demonstration of its clinical utility in diagnosing coronary disease
One hundred fifty-four patients referred for coronary arteriography were prospectively studied with stress electrocardiography, stress thallium scintigraphy, cine fluoroscopy (for coronary calcifications), and coronary angiography. Pretest probabilities of coronary disease were determined based on age, sex, and type of chest pain. These and pooled literature values for the conditional probabilities of test results based on disease state were used in Bayes theorem to calculate posttest probabilities of disease. The results of the three noninvasive tests were compared for statistical independence, a necessary condition for their simultaneous use in Bayes theorem. The test results were found to demonstrate pairwise independence in patients with and those without disease. Some dependencies that were observed between the test results and the clinical variables of age and sex were not sufficient to invalidate application of the theorem. Sixty-eight of the study patients had at least one major coronary artery obstruction of greater than 50%. When these patients were divided into low-, intermediate-, and high-probability subgroups according to their pretest probabilities, noninvasive test results analyzed by Bayesian probability analysis appropriately advanced 17 of them by at least one probability subgroup while only seven were moved backward. Of the 76 patients without disease, 34 were appropriately moved into a lower probability subgroup while 10 were incorrectly moved up. We conclude that posttest probabilities calculated from Bayes theorem more accurately classified patients with and without disease than did pretest probabilities, thus demonstrating the utility of the theorem in this application.
- Research Organization:
- Cleveland Clinic Foundation, OH
- OSTI ID:
- 6355205
- Journal Information:
- Circulation; (United States), Vol. 69:3
- Country of Publication:
- United States
- Language:
- English
Similar Records
Myocardial imaging with /sup 201/Tl: an analysis of clinical usefulness based on Bayes' theorem. [Usefulness in conjunction with ECG as a screening test for coronary artery disease]
Noninvasive diagnostic test choices for the evaluation of coronary artery disease in women: a multivariate comparison of cardiac fluoroscopy, exercise electrocardiography and exercise thallium myocardial perfusion scintigraphy
Related Subjects
CARDIOVASCULAR DISEASES
DIAGNOSIS
CORONARIES
BIOMEDICAL RADIOGRAPHY
HEART
SCINTISCANNING
PATIENTS
PROBABILITY
STATISTICAL MODELS
ARTERIES
BLOOD VESSELS
BODY
CARDIOVASCULAR SYSTEM
COUNTING TECHNIQUES
DIAGNOSTIC TECHNIQUES
DISEASES
MATHEMATICAL MODELS
MEDICINE
NUCLEAR MEDICINE
ORGANS
RADIOISOTOPE SCANNING
RADIOLOGY
550601* - Medicine- Unsealed Radionuclides in Diagnostics
550602 - Medicine- External Radiation in Diagnostics- (1980-)