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Comment & Response
January 10, 2017

Alternatives in the Evaluation of Suspected Coronary Heart Disease—Reply

Author Affiliations
  • 1Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
  • 2Clinical Trials Research Unit, University of Leeds, Leeds, United Kingdom
  • 3British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
JAMA. 2017;317(2):212-213. doi:10.1001/jama.2016.18335

In Reply As pointed out by Drs Bittencourt and Fernandes, the Duke score has recently been shown to overestimate the pretest likelihood of obstructive CHD, and improved risk models are now available.1 However, when CE-MARC 2 commenced, we used the most up-to-date clinical guidelines for the investigation of stable chest pain, and these incorporated the Duke score. Although improved models now exist, as this was a pragmatic trial rather than a diagnostic accuracy study, we cannot evaluate the effect of the newer scores.

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