Pontone Gianluca, Rossi Alexia, Gimelli Alessia, Neglia Danilo
Department of Periooperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy.
Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.
Atherosclerosis. 2023 Nov;385:117315. doi: 10.1016/j.atherosclerosis.2023.117315. Epub 2023 Oct 5.
In patients presenting with chest pain, current guidelines recommend the use of coronary computed tomography angiography and single-photon emission tomography/positron emission tomography, both with equal class 1 indication and level of evidence A. There is no clear recommendation on which test should be used as a first-line test. The choice of the test should be based on individualized clinical risk assessment, patient characteristics, local expertise/availability, and patient preferences. In this context, it is fair to ask which non-invasive imaging test to choose. The debate reproduced in this article answers this question by summarizing the considerations in selecting present state-of-the-art criteria of the right test for the right patient to ensure efficient resource utilization, minimize unnecessary testing, and maximize diagnostic accuracy and therapeutic efficacy.
对于出现胸痛的患者，当前指南推荐使用冠状动脉计算机断层扫描血管造影术和单光子发射计算机断层扫描/正电子发射断层扫描，二者均具有同等的1类适应证和A类证据水平。对于应将哪种检查用作一线检查尚无明确推荐。检查的选择应基于个体化的临床风险评估、患者特征、当地的专业技术/可及性以及患者偏好。在这种情况下，询问选择哪种非侵入性成像检查是合理的。本文重现的这场辩论通过总结为合适的患者选择合适检查的当前最先进标准时的考量因素，回答了这个问题，以确保有效利用资源、尽量减少不必要的检查，并最大限度提高诊断准确性和治疗效果。
