Coronary Artery Calcium Testing in Symptomatic Patients: An Issue of Diagnostic Efficiency

被引：13

作者：

McBride C.B. ^{[1
]}

Cheezum M.K. ^{[1
]}

Gore R.S. ^{[1
]}

Pathirana I.N. ^{[2
]}

Slim A.M. ^{[3
]}

Villines T.C. ^{[1
]}

机构：

[1] Cardiology Service, Walter Reed National Military Medical Center, Bethesda, MD, 20850

[2] Department of Medicine, Walter Reed National Military Medical Center, Bethesda, MD, 20850

[3] Cardiology Service, San Antonio Military Medical Center, San Antonio, TX, 78234

来源：

Current Cardiovascular Imaging Reports | 2013年 / 6卷 / 3期

关键词：

Cardiac computed tomography; Cardiovascular risk; Chest pain; Coronary artery calcification; Coronary artery disease; Coronary calcium; Coronary computed tomography angiography; Coronary heart disease; Guidelines; Stress testing;

D O I：

10.1007/s12410-013-9198-0

中图分类号：

学科分类号：

摘要：

The detection and quantification of coronary artery calcification (CAC) significantly improves cardiovascular risk prediction in asymptomatic patients. Many have advocated for expanded CAC testing in symptomatic patients based on data demonstrating that the absence of quantifiable CAC in patients with possible angina makes obstructive coronary artery disease (CAD) and subsequent adverse events highly unlikely. However, the widespread use of CAC testing in symptomatic patients may be limited by the high background prevalence of CAC and its low specificity for obstructive CAD, necessitating additional testing ('test layering') in a large percentage of eligible patients. Further, adequately powered prospective studies validating the comparative effectiveness of a 'CAC first' approach with regards to cost, safety, accuracy and clinical outcomes are lacking. Due to marked reductions in patient radiation exposure and higher comparative accuracy and prognostic value make coronary computed tomographic angiography the preferred CT-based test for appropriately selected symptomatic patients. © 2013 Springer Science+Business Media New York (outside the USA).

引用

页码：211 / 220

页数：9

共 67 条

[1]

Bhuiya F.A., Pitts S.R., McCaig L.F., Emergency department visits for chest pain and abdominal pain: United States, 1999-2008, NCHS Data Brief., pp. 1-8, (2010)

[2]

Skinner J.S., Smeeth L., Kendall J.M., Adams P.C., Timmis A., NICE guidance. Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin, Heart, 96, pp. 974-978, (2010)

[3]

Gianrossi R., Detrano R., Mulvihill D., Et al., Exercise-induced ST depression in the diagnosis of coronary artery disease. A meta-analysis, Circulation, 80, pp. 87-98, (1989)

[4]

Fox K., Garcia M.A., Ardissino D., Et al., Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology, Eur Heart J, 27, pp. 1341-1381, (2006)

[5]

Fihn S.D., Gardin J.M., Abrams J., Et al., 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Car, J Am Coll Cardiol, 60, (2012)

[6]

Fleischmann K.E., Hunink M.G., Kuntz K.M., Douglas P.S., Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance, Jama, 280, pp. 913-920, (1998)

[7]

Heijenbrok-Kal M.H., Fleischmann K.E., Hunink M.G., Stress echocardiography, stress single-photon-emission computed tomography and electron beam computed tomography for the assessment of coronary artery disease: a meta-analysis of diagnostic performance, Am Heart J, 154, pp. 415-423, (2007)

[8]

Duvall W.L., Wijetunga M.N., Klein T.M., Et al., Stress-only Tc-99m myocardial perfusion imaging in an emergency department chest pain unit, J Emerg Med, 42, pp. 642-650, (2012)

[9]

Samad Z., Hakeem A., Mahmood S.S., Et al., A meta-analysis and systematic review of computed tomography angiography as a diagnostic triage tool for patients with chest pain presenting to the emergency department, J Nucl Cardiol, 19, pp. 364-376, (2012)

[10]

Schuetz G.M., Zacharopoulou N.M., Schlattmann P., Dewey M., Meta-analysis: noninvasive coronary angiography using computed tomography versus magnetic resonance imaging, Ann Intern Med, 152, pp. 167-177, (2010)

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