Vargas Jose, Lima Joao A C, Kraus William E, Douglas Pamela S, Rosenberg Steven
MedStar Georgetown University Hospital, Washington, DC, USA.
PLoS Curr. 2013 Aug 26;5:ecurrents.eogt.0f04f6081905998fa92b99593478aeab. doi: 10.1371/currents.eogt.0f04f6081905998fa92b99593478aeab.
The determination of the underlying etiology of symptoms suggestive of obstructive coronary artery disease (CAD, ≥50% stenosis in a major coronary artery) is a common clinical challenge in both primary care and cardiology clinics. Usual care in low to medium risk patients often involves a family history, risk factor assessment, and then stress testing with or without non-invasive imaging. If positive, this is often followed by invasive coronary angiography (ICA). Despite extensive adoption of this usual care paradigm, more than 60% of patients referred for angiography do not have obstructive CAD. In order to robustly identify those symptomatic patients without obstructive CAD, who can avoid subsequent cardiac testing and look elsewhere for the cause of their symptoms, a recently described whole blood gene expression score (GES: Corus® CAD, CardioDx, Inc., Palo Alto, CA) has been developed and validated in two multi-center trials. This paper reviews the published literature and assessments by independent parties regarding the analytical and clinical validity as well as the clinical utility of the Corus® CAD test.
确定提示阻塞性冠状动脉疾病（CAD，主要冠状动脉狭窄≥50%）症状的潜在病因，是初级保健诊所和心脏病诊所常见的临床挑战。低至中度风险患者的常规护理通常包括家族史、风险因素评估，然后进行有或无无创成像的负荷试验。如果结果呈阳性，通常随后会进行有创冠状动脉造影（ICA）。尽管广泛采用了这种常规护理模式，但超过60%接受血管造影检查的患者没有阻塞性CAD。为了准确识别那些没有阻塞性CAD的有症状患者，他们可以避免后续的心脏检查，并从其他方面寻找症状原因，最近描述的全血基因表达评分（GES：Corus®CAD，CardioDx公司，加利福尼亚州帕洛阿尔托）已在两项多中心试验中得到开发和验证。本文回顾了独立机构发表的关于Corus®CAD检测的分析和临床有效性以及临床实用性的文献和评估。
