title: ACR appropriateness criteria asymptomatic patient at risk for coronary artery disease.
abstract: Atherosclerotic cardiovascular disease is the leading cause of death for both men and women in the United States. Coronary artery disease has a long asymptomatic latent period and early targeted preventive measures can reduce mortality and morbidity. It is important to accurately classify individuals at elevated risk in order to identify those who might benefit from early intervention. Imaging advances have made it possible to detect subclinical coronary atherosclerosis. Coronary artery calcium score correlates closely with overall atherosclerotic burden and provides useful prognostic information for patient management. Our purpose is to discuss use of diagnostic imaging in asymptomatic patients at elevated risk for future cardiovascular events. The goal for these patients is to further refine targeted preventative efforts based on risk. The following imaging modalities are available for evaluating asymptomatic patients at elevated risk: radiography, fluoroscopy, multidetector CT, ultrasound, MRI, cardiac perfusion scintigraphy, echocardiography, and PET. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors: Fairfax Radiological Consultants, Fairfax, Virginia. Electronic address: jpearls@yahoo.com.
authors: James P
authors: JP
authors: Earls
authors: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri.
authors: Pamela K
authors: PK
authors: Woodard
authors: Massachusetts General Hospital, Boston, Massachusetts.
authors: Suhny
authors: S
authors: Abbara
authors: VA Medical Center, Philadelphia, Pennsylvania.
authors: Scott R
authors: SR
authors: Akers
authors: Mayo Clinic, Rochester, Minnesota.
authors: Philip A
authors: PA
authors: Araoz
authors: Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri.
authors: Kristopher
authors: K
authors: Cummings
authors: Baptist Hospital of Miami, Kendall, Florida.
authors: Ricardo C
authors: RC
authors: Cury
authors: Brigham and Women's Hospital, Boston, Massachusetts, Society of Nuclear Medicine.
authors: Sharmila
authors: S
authors: Dorbala
authors: Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors: Udo
authors: U
authors: Hoffmann
authors: Kaiser Permanente, Los Angeles, California.
authors: Joe Y
authors: JY
authors: Hsu
authors: New York University Medical Center, New York, New York.
authors: Jill E
authors: JE
authors: Jacobs
authors: Cedars Sinai Medical Center, Los Angeles, California, American College of Cardiology.
authors: James K
authors: JK
authors: Min
mesh_terms: D058070:Asymptomatic Diseases; D002309:Cardiology / Q000592:standards*; D017023:Coronary Angiography / Q000592:standards*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D011871:Radiology / Q000592:standards*; D018570:Risk Assessment / Q000592:standards; D014481:United States
keywords: Appropriateness criteria; asymptomatic; coronary artery calcium score; coronary artery disease; multidetector CT (MDCT)