[A comparative study of 4 diagnostic strategies in coronary artery disease. A theoretical approach].
The prognosis of patients with coronary artery disease is constantly improving mainly due to better control of risk factors, to improved methods of myocardial revascularisation and better follow-up. For effective management, the diagnosis of coronary disease has to be established. The authors used a statistical model to study the efficacy of 4 diagnostic strategies used in daily practice: (i) three investigations in two stages: exercise stress testing, stress echocardiography or stress scintigraphy followed by coronary angiography when positive (EE, ECHO, SCINTI): (ii) one stage investigation: coronary angiography of first indication (CORO). When the a priori probability is low or moderate (less than 0.5) the efficacy of EE, ECHO and SCINTI is excellent as there are few false negative results. When the a priori probability of coronary disease is high (0.7 or more), the percentage of false negative results (patients with undetected significant coronary disease) becomes very high. At this level of risk the CORO strategy avoids the false negatives without increasing the costs with respect to the other strategies. In conclusion, the choice of diagnostic strategy of coronary artery disease should take into account the "a priori" risk of the patient. When high (> 0.7), coronary angiography of first intention seems to be statistically justified.
Henry
P
P
Département de cardiologie, hôpital Broussais, Paris.
Makowski
S
S
Guermonprez
J L
JL
Guize
L
L
D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003327:Coronary Disease / Q000175:diagnosis*; D003362:Cost-Benefit Analysis; D004452:Echocardiography / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005080:Exercise Test; D005188:False Negative Reactions; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000009:adverse effects / Q000191:economics / Q000379:methods*
D013794:Thallium Radioisotopes
Etude comparée de quatre stratégies diagnostiques de la maladie coronaire. Approache théorique.