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NICE 指南是否应该被普遍接受用于稳定型冠心病的评估?一场辩论。

Should NICE guidelines be universally accepted for the evaluation of stable coronary disease? A debate.

机构信息

Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Saint Luke's Medical Center, 1111 Amsterdam Ave, New York, NY, USA.

Department of Radiology, Weill Cornell Medicine, 497 East, 61st St., NY, USA.

出版信息

Eur Heart J. 2019 May 7;40(18):1440-1453. doi: 10.1093/eurheartj/ehz024.

DOI:10.1093/eurheartj/ehz024
PMID:30815672
Abstract

The 2016 National Institute of Health and Care Excellence clinical guideline for the assessment and diagnosis of chest pain positions coronary computed tomography angiography as the first test for all stable chest pain patients without confirmed coronary artery disease and discards the previous emphasis on calculation of pre-test likelihood recommended in their 2012 edition of the guidelines. On the other hand, the American College of Cardiology Foundation/American Heart Association and the European Society of Cardiology guidelines continue to present the stress testing functional modalities as the tests of choice. The aim of this review is to present, in the form of a debate, the pros and cons of these paradigm changing recommendations, with an emphasis on literature review and projection of future needs, with conclusions to be drawn by the reader.

摘要

2016 年,国家卫生与保健卓越研究所(NICE)发布了胸痛评估与诊断临床指南,将冠状动脉计算机断层血管造影(CCTA)作为所有无确诊冠状动脉疾病的稳定型胸痛患者的首选检查方法,摒弃了之前指南(2012 年版)中强调计算预测值的做法。另一方面,美国心脏病学会基金会/美国心脏协会(ACCF/AHA)和欧洲心脏病学会(ESC)指南仍将应激测试功能方式作为首选检查方法。本综述旨在以辩论的形式介绍这些改变范式的建议的优缺点,重点是文献回顾和对未来需求的预测,由读者得出结论。

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