Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
COST-EFFECTIVE SELECTION OF PATIENTS FOR CORONARY ANGIOGRAPHY
Autore:
MADDAHI J; GAMBHIR SS;
Indirizzi:
UNIV CALIF LOS ANGELES,SCH MED,DEPT MOL & MED PHARMACOL,DIV NUCL MED & BIOPHYS,100 MED PLAZA 410 LOS ANGELES CA 90095 UNIV CALIF LOS ANGELES,SCH MED,DEPT MOL & MED PHARMACOL,CRUMP INST BIOL IMAGING LOS ANGELES CA 90095 UNIV CALIF LOS ANGELES,SCH MED,DEPT BIOMATH LOS ANGELES CA 90095
Titolo Testata:
Journal of nuclear cardiology
fascicolo: 2, volume: 4, anno: 1997,
parte:, 2 supplemento:, S
pagine: 141 - 151
SICI:
1071-3581(1997)4:2<141:CSOPFC>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
EMISSION COMPUTED-TOMOGRAPHY; ISCHEMIC-HEART-DISEASE; ARTERY DISEASE; TL-201 TOMOGRAPHY; N-13 AMMONIA; EXERCISE; DIAGNOSIS; STRESS; SCINTIGRAPHY; N-13-AMMONIA;
Keywords:
COST-EFFECTIVENESS; DIAGNOSIS; PROGNOSIS; CAD NUCLEAR CARDIOLOGY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
32
Recensione:
Indirizzi per estratti:
Citazione:
J. Maddahi e S.S. Gambhir, "COST-EFFECTIVE SELECTION OF PATIENTS FOR CORONARY ANGIOGRAPHY", Journal of nuclear cardiology, 4(2), 1997, pp. 141-151

Abstract

In patients suspected of having coronary artery disease (CAD), noninvasive testing has been playing an increasing role in selecting patients who would require coronary angiography for either the ''definitive''diagnosis of CAD or as a prelude to planning myocardial revascularization. A mathematic model is presented that defines cost-effective utility of nuclear cardiology testing for diagnosis of CAD and selection of appropriate candidates for coronary angiography, according to quantitative methods of decision analysis. Clinical utility or effectivenesswas defined in terms of percent correct diagnosis of CAD. Cost was defined as dollars of medical expenditure. Sis competing strategies werecompared in subsets of patients with different pretest likelihoods ofCAD, based on age, sex, and symptoms. Nuclear cardiology testing was the most cost-effective initial modality of choice in patients with anintermediate pretest likelihood of CAD. In patients with a low pretest likelihood of CAD, nuclear cardiology testing was cost-effective in the subgroup of patients who had abnormal exercise treadmill electrocardiograms. In patients with a high pretest likelihood of CAD, direct referral to coronary angiography was the most cost-effective strategy for diagnosis of CAD. Coronary angiography, however, is performed most often as a prelude to myocardial revascularization. Because these invasive procedures are indicated only in patients who are at high risk with medical therapy, nuclear cardiology procedures, by virtue of incremental prognostic information, identify appropriate candidates for moreinvasive procedures, aimed at improving survival. Strategies for cost-effective prognostication of CAD depend on not only the patient's pretest likelihood of CAD but also the status of the rest electrocardiogram. In patients with a normal rest electrocardiogram a low pretest likelihood of CAD indicates a low risk for cardiac events with medical therapy. Therefore coronary angiography is not indicated in these patients. Patients with an intermediate likelihood of CAD should first undergo exercise electrocardiographic testing; a negative response mould indicate a low risk for cardiac events and a positive response would indicate the need for nuclear cardiology testing for further cost-effective risk stratification. In patients with a high pretest likelihood of CAD, the combined exercise electrocardiographic and nuclear cardiac testing is the most cost-effective strategy; a negative or a positive nuclear test result would imply low or high risk, respectively. The latter patients mould then be candidates for coronary angiography. In all patients with an abnormal rest electrocardiogram, the most cost-effective strategy is uniform referral to nuclear cardiac testing (which is performed in conjunction with exercise electrocardiography), regardless of the pretest likelihood of CAD; a negative or a positive nuclear test result would indicate low or high risk for coronary events, respectively. The latter group would be proper candidates for referral to coronary angiography.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/01/20 alle ore 04:40:49