Key result
Non-invasive testing for the diagnosis of coronary artery disease is rarely appropriate in asymptomatic subjects, with the main benefit of testing seen in patients with an intermediate pre-test probability.
Why the study?
What is the appropriate use of non-invasive testing for the diagnosis of coronary artery disease based on pre-test probability?
What is the appropriate use of non-invasive testing for the diagnosis of coronary artery disease based on pre-test probability?
Appropriate prescription of non-invasive CAD testing requires clinical evaluation of pre-test probability, with testing generally discouraged in asymptomatic and low-risk individuals.
Supports targeted non-invasive CAD testing in intermediate pre-test probability; leaves open optimal strategies for asymptomatic and diabetic patients.
In the last three decades also in our country it has been a huge growth of the use of non invasive testing for diagnosis of CAD. Therefore, appropriateness of prescription in diagnostic testing is crucial. Clinical evaluation is mandatory before a diagnostic test, including the evaluation of pre-test probability of the disease based on symptoms, age, sex and cardiovascular risk factors. The main benefit of testing is in patients with an intermediate pre-test probability. Testing for diagnosis of CAD is rarely appropriate in asymptomatic subjects, except for ECG exercise test in intermediate and high risk individuals, while stress or anatomic imaging is preferable in higher risk individuals. Coronary calcium score should not be used as screening test in asymptomatic subjects, except for excluding CAD in those with low pre-test probability. As far as diabetic patients is concerned, available evidence indicates an unfavorable risk-benefit ratio of extensive CAD screening, except in the presence of high clinical suspicion.
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Pasquale et al. (2015) conducted a review in Coronary artery disease. Non-invasive diagnostic testing was evaluated. Non-invasive testing for the diagnosis of coronary artery disease is rarely appropriate in asymptomatic subjects, with the main benefit of testing seen in patients with an intermediate pre-test probability.
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