Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA 30322, USA.
Department of Medicine Division of Cardiology, Emory University, Atlanta, GA 30322, USA.
Br J Radiol. 2020 Sep 1;93(1113):20190764. doi: 10.1259/bjr.20190764. Epub 2020 Apr 23.
Stable ischemic heart disease remains a major cause of morbidity and mortality. Although there are multiple imaging modalities to diagnose and/or assist in the clinical management, the most cost-effective approach remains unclear. We reviewed the relevant and recent evidence-based clinical studies and trials to suggest the most cost-effective approach to stable ischemic heart disease. The limitations of these studies are discussed. Incorporating the results of recent multicenter trials, we suggest that for appropriate patients with coronary artery disease with any degree of stenosis or presence of coronary calcium, optimal medical therapy may be most cost-effective. Invasive coronary angiography and/or coronary revascularization would be primarily for non-responders or >/=50% left main stenosis. Stress cardiac magnetic imaging would be performed for those patients with non-diagnostic coronary CT angiography from motion and non-responders from optimal medical therapy in non-diagnostic coronary CT angiography group from high coronary calcium. These paths seem to be safe and cost-effective but requires modeling for confirmation.
稳定型缺血性心脏病仍然是发病率和死亡率的主要原因。尽管有多种成像方式可用于诊断和/或协助临床管理，但最具成本效益的方法仍不清楚。我们回顾了相关的、最近的基于证据的临床研究和试验，以提出稳定型缺血性心脏病最具成本效益的方法。讨论了这些研究的局限性。结合最近多中心试验的结果，我们建议对于任何程度狭窄或存在冠状动脉钙的适当的冠状动脉疾病患者，最佳的药物治疗可能是最具成本效益的。对于非反应者或> / = 50%左主干狭窄的患者，将进行有创冠状动脉造影和/或冠状动脉血运重建。对于那些在非诊断性冠状动脉 CT 血管造影检查中因运动而出现不明确结果的患者，以及在非诊断性冠状动脉 CT 血管造影检查中对最佳药物治疗无反应的患者，将进行心脏磁共振成像检查，这些患者的冠状动脉钙含量较高。这些方法似乎是安全且具有成本效益的，但需要建立模型进行确认。
