[Diagnosis of coronary artery disease--part 1: general approach].
Tests for the diagnosis of coronary artery disease (CAD) rely on two main diagnostic principles, that is direct visualisation of coronary anatomy or detection of stress-induced myocardial ischaemia. Whether a given test is useful for the patient's management critically depends on the clinical context, that is pre-test probability for significant CAD. Not every test is suitable for every patient. Non-invasive tests have the highest diagnostic yield in patients with chest pain and intermediate pre-test probability. In these patients, tests typically confirm the presence of CAD or make it highly unlikely. In patients with low or high pre-test probability, non-invasive tests provide hardly any added diagnostic information. However, in patients with high pre-test probability of CAD, non-invasive tests are helpful for risk stratification. In asymptomatic patients, there is no established indication for any tests apart from calculation of a global cardiovascular risk based on traditional risk factors and initiation of primary preventive measures if appropriate.
Baker IDI Heart and Diabetes Institute, Heart Center, Alfred Hospital, Melbourne, Victoria, Australien. micha.maeder@bluewin.ch
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000175:diagnosis*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000175:diagnosis*; D023921:Coronary Stenosis / Q000175:diagnosis*; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis