Design and Rationale of GPS-CAD

BACKGROUND: Atherosclerotic coronary artery disease (ACAD) is a prevalent condition causing a significant number of deaths worldwide. Even though Asian and other non-Western regions are the main drivers of future increase, there are insufficient data on ACAD patterns in those regions. Pretest probability (PTP) tools developed to evaluate patients with stable chest pain for coronary artery disease were largely developed in predominantly White Western populations, limiting their application on a global scale. OBJECTIVES: The aims of the Global Pretest Probability Study of Coronary Artery Disease (GPS-CAD) are to define the importance of ancestry, race, ethnicity and environment on ACAD patterns across diverse populations, evaluate current PTP tools and potentially create new algorithm(s) that are more aligned with a diverse global population. METHODS: GPS-CAD is a multicenter retrospective cross-sectional observational study of individuals referred for computed tomography owing to suspected ACAD. The target enrolment is 100,000 participants across 6 continents. Data on demographics, cardiovascular risk factors, race, ethnicity and medications will be collected. The primary endpoints of ACAD are defined as: 1) coronary artery calcium score >0; 2) any coronary plaque (>0% stenosis); or 3) obstructive CAD (≥50% stenosis). RESULTS: Data from more than 60,000 participants have been ingested thus far across 17 countries, with a mean age of 56.43 years and 41.55% female. CONCLUSIONS: By understanding the varying influence of factors and phenotypes of ACAD across diverse groups, GPS-CAD will facilitate the development of locally contextualized strategies to tackle this dominant and growing healthcare burden. (Global Pretest Probability Study of Coronary Artery Disease [GPS-CAD; NCT05722145]).