Novel risk model predicting high-risk coronary artery disease: let common sense prevail in medical decision making.

W ithin the wider context of health care delivery sciences, the focus on medical decision making is a fairly recent occurrence. Dr. Lee Lusted (1), a pioneer in medical decision analytics, published the first major article emphasizing this theme in 1971. A few years later, New England Journal of Medicine (2) followed suit, by dedicating an entire issue to emerging concepts around decision making in medicine. In a classic 1976 editorial, “Is decision analysis useful in clinical medicine?” Ransohoff and Feinstein (3) questioned “Will decision analysis prove to be useful in clinic medicine? Is it worthwhile to learn about this new field?” During the 1970s, I reckon they probably could not predict how rapidly this concept would penetrate medical literature and particularly influence cardiovascular medicine. Over the next 3 decades, hardly any other topic has received as much attention as risk modeling to facilitate decision making for accurate prediction of the presence and severity of coronary artery disease (CAD). In 1979, Diamond and Forrester (4) recommended principles of decision analysis by presenting a simple, classic model that considers age, sex, and type of chest pain to determine the likelihood of obstructive CAD guiding downstream management. Subsequently, multiple other risk scores were formulated