coronary disease, chest pain
DISEASE INTERVENTION COMPARISON RESULTS
Ann Intern Med. 2010 May 18;152(10):630-9 Cohorts
IN coronary disease, chest pain The Use of
coronary multidetector computed tomography, computed tomography coronary angiography
As Diagnostic Tool
Is better Than
stress testing
To screen for coronary disease, specially in patients at intermediate pre-test probability (+ results indicated 93% need for coronary angiography and negative results indicated no need for further testing (1% + cases).
N Engl J Med. 1997 Dec 4;337(23):1648-53 Cohorts
IN coronary disease, chest pain, acute coronary syndrome The Use of
troponin I, troponin T
As Diagnostic Tool
Is better Than
CPK and ECG alone
To identify early patients at risk to develop myocardial infartion or death from cardiac causes: For the 34 total events (20 deaths, 14 infarctions), troponin I was positive in 32 and negative in 2. Troponin T was positive in 27 and negative in 7.
Lancet. 2012 Feb 4;379(9814):453-60 Diagnostic
IN coronary disease, chest pain, high risk patients The Use of
magnetic resonance imaging (MRI) of the heart, with adenosine stress
As Diagnostic Tool
Is better Than
single-photon emission computed tomography (SPECT), with adenosine stress, perfusion scintigraphy
To diagnose significant coronary disease (gold standard : coronary angiography) : IRM sensitivity 86%, specificity 83% ; SPECT sensitivity 66%, specificity 82%
Heart. 2010 Dec;96(24):1973-9 Diagnostic
IN coronary disease, chest pain, low to intermediate risk patients The Use of
coronary multidetector computed tomography, 64-slice CT coronary angiography
As Diagnostic Tool
Is better Than
exercise ECG testing (invasive coronariography as reference test)
To accurately diagnose significant coronary disease: sensitivity 100%, specificity 98.7%, positive and negative predictive values 92.9% and 100%, at the patient level (as opposed to analysis by coronary segment)