Christiaan JM Vrints

There is one thing that, even as a reviewer and despite having pointed it out during the process, I really haven't understood about the new ESC guidelines for chronic coronary syndromes. Using the new Risk factor-weighted clinical likelihood (RF-CL) model, one can calculate individual risk based on symptoms, sex, and the number of cardiovascular risk factors, and so far so good. In this way, the calculable pre-test probability scores range from 0 to 45%. However, the recommendations for additional diagnostic tests are also applicable to patients with a risk higher than 45%. Now, how does one calculate a pre-test probability higher than 45% based on the RF-CL? With risk enhancers like PAD, resting ECG, etc.? With the calcium score? In fact, the calcium score can be used to determine the new pre-test probability, but I don’t think this is a good reason to perform it on everyone, also because its value lies mainly in recategorizing patients into the very low-risk group when it is zero. However, it seems you cannot determine the new pre-test probability with risk enhancers, unless it is meant that the presence of one of these factors automatically shifts the patient into at least the moderate-risk category. In short, if anyone has figured out how to arrive at the precise number for values above 45%, they’d be doing me a favor, because I can't understand it from the text.