Inappropriate testing for the diagnosis of coronary artery disease

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-tes...

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Bibliographic Details
Published inItalian journal of medicine Vol. 9; no. 3; pp. 229 - 233
Main Authors Di Pasquale, Giuseppe, Coutsoumbas, Gloria Vassilikì, Zagnoni, Silvia
Format Journal Article
LanguageEnglish
Published PAGEPress Publications 01.01.2015
Subjects
appropriateness
Coronary artery disease
risk assessment
screening test
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Summary: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.
ISSN:1877-9344
1877-9352
DOI:10.4081/itjm.2015.555