Criteria issued for tests for stable ischemic heart disease
Michael J. Wolk, M.D., from Weill Cornell Medical College in New York City, and colleagues considered use of seven testing modalities in an appropriate use review of 80 common clinical presentations in stable ischemic heart disease. The tests (exercise electrocardiogram, stress radionuclide imaging, stress echocardiography, stress cardiac magnetic resonance, calcium scoring, coronary computed tomography angiography, and invasive coronary angiography) were rated side-by-side for the same indication and ranked as "Appropriate," "May Be Appropriate," or "Rarely Appropriate."
For patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope, the use of some modalities of testing was generally found to be Appropriate or May Be Appropriate in initial evaluation. Testing to assess new or worsening symptoms following a previous test or procedure was Appropriate. For patients within 90 days of an abnormal or uncertain prior result, testing was Appropriate or May Be Appropriate. Preoperative testing was rated Appropriate or May Be Appropriate for patients with poor functional capacity undergoing vascular or immediate risk surgery with at least one risk factor or an organ transplant.
"The goal of the document is not to rank order diagnostic tests but to help guide physicians and patients when it comes to making reasonable testing choices amongst the available testing modalities," Wolk said in a statement.
Several authors disclosed financial ties to the pharmaceutical and medical device industries.
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