Hulten Edward A, Malhotra Saurabh, Tandon Suman
Departments of Medicine, Cardiology Service, Fort Belvoir Community Hospital, DeWitt Loop 9300, Fort Belvoir, VA, 22060, USA.
Walter Reed National Military Medical Center, Bethesda, MD, USA.
J Nucl Cardiol. 2021 Apr;28(2):735-740. doi: 10.1007/s12350-020-02519-0. Epub 2021 Jan 28.
We advocate an evidence-based discussion for a patient first philosophy when considering "the right test for the right patient." Numerous test options exist for the evaluation of symptoms of possible stable ischemic heart disease. Major guidelines have traditionally focused on functional testing with or without imaging to clarify symptoms, diagnose ischemia, stratify prognosis, and guide management. Recently, industry advocates have emphasized modality-specific approaches such as computed tomography (CT First) as an initial test strategy for possible stable CAD. We review the key evidence to demonstrate that current best practice would focus on a patient first approach rather than a modality-specific approach.
在考虑“为合适的患者选择合适的检查”时，我们提倡基于证据、以患者为先的理念进行讨论。对于评估可能的稳定型缺血性心脏病症状，有多种检查选项。传统上，主要指南侧重于使用或不使用影像学的功能检查，以明确症状、诊断缺血、分层预后并指导治疗。最近，行业倡导者强调了特定检查方式的方法，如计算机断层扫描（CT优先）作为可能的稳定型冠心病的初始检查策略。我们回顾关键证据以证明当前的最佳实践应侧重于以患者为先的方法，而非特定检查方式的方法。
