Department of Radiology, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, the Netherlands.
J Am Coll Cardiol. 2011 Apr 12;57(15):1591-600. doi: 10.1016/j.jacc.2010.10.055.
The purpose of this study was to critically appraise guidelines on imaging of asymptomatic coronary artery disease (CAD).
Various imaging tests exist to detect CAD in asymptomatic persons. Because randomized controlled trials are lacking, guidelines that address the use of CAD imaging tests may disagree.
Guidelines in English published between January 1, 2003, and February 26, 2010, were retrieved using MEDLINE, Cumulative Index to Nursing and Allied Health Literature, the National Guideline Clearinghouse, the National Library for Health, the Canadian Medication Association Infobase, and the Guidelines International Network International Guideline Library. Guidelines developed by national and international medical societies from Western countries, containing recommendations on imaging of asymptomatic CAD were included. Rigor of development was scored by 2 independent reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument. One reviewer performed full extraction of recommendations, which was checked by a second reviewer.
Of 2,415 titles identified, 14 guidelines met our inclusion criteria. Eleven of 14 guidelines reported relationship with industry. The AGREE scores varied across guidelines from 21% to 93%. Two guidelines considered cost effectiveness. Eight guidelines recommended against or found insufficient evidence for testing of asymptomatic CAD. The other 6 guidelines recommended imaging patients at intermediate or high CAD risk based on the Framingham risk score, and 5 considered computed tomography calcium scoring useful for this purpose.
Guidelines on risk assessment by imaging of asymptomatic CAD contain conflicting recommendations. More research, including randomized controlled trials, evaluating the impact of imaging on clinical outcomes and costs is needed.
本研究旨在对无症状冠状动脉疾病（CAD）影像学检查指南进行批判性评估。
存在多种影像学检查方法可用于检测无症状人群的 CAD。由于缺乏随机对照试验，因此针对 CAD 影像学检查使用的指南可能存在分歧。
使用 MEDLINE、护理学和联合健康文献累积索引、国家指南清理中心、国家卫生图书馆、加拿大药物协会 Infobase 和指南国际网络国际指南库，检索 2003 年 1 月 1 日至 2010 年 2 月 26 日期间发表的英文指南。纳入包含无症状 CAD 影像学检查建议的西方国家国家和国际医学协会制定的指南。2 位独立评审员使用评估指南研究和评估（AGREE）工具对指南制定的严谨性进行评分。其中一位评审员对建议进行了全面提取，由另一位评审员进行核对。
在 2415 篇标题中，有 14 项指南符合我们的纳入标准。14 项指南中有 11 项报告与行业有关。AGREE 评分在各指南之间差异较大，从 21%到 93%不等。有 2 项指南考虑了成本效益。8 项指南反对或发现对无症状 CAD 进行检测的证据不足。其他 6 项指南建议根据弗雷明汉风险评分对具有中危或高危 CAD 风险的患者进行影像学检查，其中 5 项指南认为计算机断层扫描钙评分对此有用。
关于无症状 CAD 影像学评估风险的指南包含相互矛盾的建议。需要更多的研究，包括随机对照试验，来评估影像学对临床结局和成本的影响。
