Comparative assessment of pre‑test probability models for coronary artery disease (RSC 2024 vs ESC 2024) in patients with type 2 diabetes mellitus: implications for diagnostic strategy and revascularization
https://doi.org/10.33667/2078-5631-2026-11-30-34
Abstract
Background. Patients with type 2 diabetes mellitus (T2DM) frequently present with atypical or non‑anginal manifestations of coronary artery disease (CAD), complicating clinical risk stratification. Current guidelines propose different approaches to pre‑test probability (PTP) assessment; however, their comparative performance in diabetic populations remains insufficiently explored.
Aim. To compare CAD PTP assessed by the Russian Society of Cardiology (RSC) 2024 and ESC2024 models in patients with T2DM and suspected CAD, and to evaluate their prognostic value.
Materials and methods. A total of 101 patients with T2DM and suspected CAD were included. PTP was assessed using the RSC2024 and ESC2024 models. Clinical presentation, cardiovascular risk factors, and rates of coronary angiography (CAG) and percutaneous coronary intervention (PCI) were analyzed. Prognostic value was assessed using Cox regression, ROC analysis, and Kaplan–Meier survival curves.
Results. Non‑anginal and atypical symptoms predominated; typical angina was present in 17.8 % of patients. Most patients had ≥3 cardiovascular risk factors. PTP estimates differed significantly between the RSC2024 and ESC2024 models (p=0.001), with ESC2024 yielding lower PTP values and shifting patients toward lower‑risk categories. During a median follow‑up of 519 [357–701] days, CAG was performed in 50 patients and PCI in 30 patients. PTP assessed by the RSC2024 model was a significant predictor of revascularization (HR1.042; 95% CI 1.004–1.081; p=0.028). ROC analysis demonstrated limited discriminative ability (AUC0.62; 95% CI 0.47–0.78), with an optimal PTP cut‑off of 14%. Patients with PTP <14% had significantly higher event‑free survival (p<0.001).
Conclusions. In patients with T2DM and suspected CAD, the ESC2024 model yields lower estimated PTP compared with the RSC2024 model. The RSC2024 model demonstrates greater prognostic value for revascularization, supporting an individualized diagnostic approach.
About the Authors
A. F. Safarova
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Clinical Medicine, Institute of Medicine ; Vinogradov University Clinical Hospital – branch of Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University)
Russian Federation
Russian Federation
Safarova Ayten F., Dr Med Sci (habil.), professor at Dept of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after academician V.S. Moiseyev, ICM MI, physician at Dept of Ultrasound and Functional Research Methods
Moscow
T. M. Timofeeva
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Clinical Medicine, Institute of Medicine ; Vinogradov University Clinical Hospital – branch of Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University)
Russian Federation
Russian Federation
Timofeeva Tatyana M., PhD Med Sci, associate professor at Dept of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after academician V.S. Moiseyev, ICM MI, physician at Dept of Ultrasound and Functional Research Methods
Moscow
V. P. Efimova
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Clinical Medicine, Institute of Medicine ; Vinogradov University Clinical Hospital – branch of Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University)
Russian Federation
Russian Federation
Efimova Victoria P., PhD Med Sci, associate professor at Dept of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after academician V.S. Moiseyev, ICM MI, head of Dept of Ultrasound and Functional Research Methods
Moscow
J. I. Abdulloev
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Clinical Medicine, Institute of Medicine ; Vinogradov University Clinical Hospital – branch of Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University)
Russian Federation
Russian Federation
Abdulloev Jakhongir I., postgraduate student at Dept of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after Academician V.S. Moiseyev, ICM MI, physician at Dept of Ultrasound and Functional Research Methods
Moscow
A. A. Abramov
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Clinical Medicine, Institute of Medicine
Russian Federation
Russian Federation
Abramov Aleksey A., postgraduate student at Dept of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after Academician V.S. Moiseyev, ICM MI
Moscow
Zh. D. Kobalava
Peoples’ Friendship University of Russia named after Patrice Lumumba (RUDN University), Department of Internal Medicine with the subspecialty of cardiology and functional diagnostics named after V.S. Moiseev, Institute of Clinical Medicine, Institute of Medicine
Russian Federation
Russian Federation
Kobalava Zhanna D., Dr Med Sci (habil.), professor, RAS corresponding member, head of Dept of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after Academician V.S. Moiseyev, ICM MI
Moscow
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Review
For citations:
Safarova A.F., Timofeeva T.M., Efimova V.P., Abdulloev J.I., Abramov A.A., Kobalava Zh.D. Comparative assessment of pre‑test probability models for coronary artery disease (RSC 2024 vs ESC 2024) in patients with type 2 diabetes mellitus: implications for diagnostic strategy and revascularization. Medical alphabet. 2026;1(11):30-34. (In Russ.) https://doi.org/10.33667/2078-5631-2026-11-30-34
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