Calculator for fatal and non-fatal myocardial infarction using Carotid TPA and Coronary Calcification Percentiles    
15.03.2009

 

   by Michel Romanens and Franz Ackermann, MDs    
    1. Step: enter pretest probability for fatal or nonfatal myocardial infarction (derived from the AGLA-Algorithm) into the field "Pretest Risk"  
  Read here how to calculate coronary calcium score percentiles 2. Step: Select in the appropriate field for fatal and non-fatal AMI and an appropriate cutpoint dividing the values of the carotid total plaque area or coronary calcium score into "Test -" (left side) and "Test +" (on the right side of the cutpoint) and click the boutton "fatal + nonfatal AMI", which will immediately produce the results in step 3. The same happens when clicking on numbers on the rulers on top right (2. step field).  
    3. Step: read results for positive and negative test on the right bottom, which also displays our 95 CI of the results, which in a previous version were based on the formula by Newcombe and actually changed to the formula by Glasziou (Toronto 2000).   
    4. Step and hints: recommendations for risk lowering interventions are available at the AGLA Website. The posttest risk results calculated here may be used to change the intensity of medical intervention. This approach is thought to be especially helpful in intermediate risk subjects as assessed by the AGLA Algorithm.  
    Risk Calculator , designed by Romanens + Ackermann, CH-4600 Olten 23rd March 2004, revision 11th November 2006 ,
14th April 2007 and 15th Mars 2009

 

  
       
    Click the Score for pretest CHD-risk

    
 

1. Step

Enter Pretest-Risk (e.g. 3 = 3%) into the bottom field

  
    Pretest-Risk (for CHD-Morbidity , fatal + nonfatal AMI)
%		    

2. Step

    BAYES kernel of ROC Analysis
Cut just below the selected value declareing all following values as "Test +"

select an appropriate cutpoint declearing TPA values on his right side as "Test +", then click on the field "Fatal + nonfatal AMI" just below and then go to step 3. Instead you may use also the selectors for TPA or CCS on the right.

  Cuts

 
Carotid
TPA cm2

m + f
  Carotid
TPA mm2

male
   Carotid
TPA mm2

female
  

EBCT
CCS %

m + f
  

EBCT
CAC

male

EBCT
CAC

female
  

EBCT
CAC

m > f
Risk Groups I - cut + II - cut + III - cut + IV Best cut Incidence References

      AMI-Risk in TPA-groups		 TPA cm2
0.00 - 0.03
0.59%		 0.035
 		TPA cm2
0.04 - 0.17
0.00%		 0.175
 		TPA cm2
0.18 - 0.55
2.33%		 0.555
 		TPAcm2
0.56 - 4.83
4.65%		 1.115
 		1.90%
/ 3.0 Jahre		 Spence JD et al, 2002
Spence

      AMI-Risk in TPA-groups		 TPA mm2
0.00 - 1.51
4.25%		 1.51
 		TPA mm2
1.52 - 8.74
4.36%		 8.74
 		TPA mm2
8.75-27.69
8.75%		 27.69
 		TPA mm2
27.70-207
12.53%		 8.84
 		6.62%
/ 6.0 Jahre
Tromso

      AMI-Risk in TPA-groups		 TPA mm2
0.0 - 1.87
1.11%		 1.87
 		TPA mm2
1.88 - 8.75
2.60%		 8.75
 		TPA mm2
8.76-27.53
5.60%		 27.53
 		TPA mm2
27.54-121
9.35%		 8.43
 		3.00%
/ 6.0 Jahre		 Tromso

      AMI-Risk in CCS%-groups		 CCS %
00 - 49
0.59%		 49.5
 		CCS %
50 - 74
3.25%		 74.5
 		CCS %
75 - 89
8.57%		 89.5
 		CCS %
90 - 99
17.72%		 ?
 4.44%
/ 2.7 Jahre		 CSAMI

      AMI-Risk in CAC-groups		 CAC
0
0.64%		 < 1
CAC
1 - 100
2.35%		 100
 		CAC
101 - 400
7.40%		 400
 		CAC
> 400
9.26%		 ?
 3.58%
/ 3.75 Jahre		 Budoff MJ
et al. 2009
MESA

      AMI-Risk in CAC-groups		 CAC
0
0.37%		 < 1
CAC
1 - 100
1.98%		 100
 		CAC
101 - 400
2.95%		 400
 		CAC
> 400
5.94%		 ?
 1.33%
/ 3.75 Jahre		 MESA

      AMI-Risk in CAC-groups		 CAC
0
4.43%		 < 1
CAC
1 - 100
6.54%		 100
 		CAC
101 - 300
8.77%		 300
 		CAC
> 300
15.38%		 ?
 8.16%
/ 8.5 Jahre		 Greenland
et al. 2004
SouthBay

Endpoints

3. Step

Read Endpoint Value Here

Upper Value for Test Positivity

Lower Value for Test Negativity

 

LR+   [95% CI]

LR -   [95% CI]

Posttest-Risk % if test  positive
 % for val >=

Posttest-Risk % if test  negative
 % for val <=

   
M.R. + F.A. 15.03.2009
posttestcalculators2.html
www.scopri.ch