Stress testing and non-invasive coronary angiography in patients with suspected coronary artery disease: time for a new paradigm
Abstract
Overview
Diagnosis and management of coronary
artery disease represents major challenges to
our health care system, affecting millions of
patients each year. Until recently, the diagnosis
of coronary artery disease was possible
only through cardiac catheterization and invasive
coronary angiography. To avoid the risks
of an invasive procedure, stress testing is
often employed for an initial assessment of
patients with suspected coronary artery disease,
serving as a gatekeeper for cardiac
catheterization. With the emergence of noninvasive
coronary angiography, the question
arises if such a strategy is still sensible, particularly,
in view of only a modest agreement
between stress testing results and the presence
of coronary artery disease established by
cardiac catheterization. Much data in support
of the diagnostic accuracy and prognostic
value of non-invasive coronary angiography by
computed tomography have emerged within
the last few years. These data challenge the
role of stress testing as the initial imaging
modality in patients with suspected coronary
artery disease. This article reviews the clinical
utility, limitations, as well as the hazards of
stress testing compared with non-invasive
coronary artery imaging by computed tomography.
Finally, the implications of this review
are discussed in relation to clinical practice.
Keywords
CT angiography, stress testing, cardiac CT, coronary artery disease.
Article Information
Correspondence
Armin Arbab-Zadeh, The Johns Hopkins Hospital, 600 N. Wolfe St/Blalock 524, Baltimore, MD 21287-0409, USA. Tel. +1.410.502.0549 – Fax: +1.443.287.6624. E-mail: arminzadeh@jhu.edu
Received
2011-12-21T00:00:00
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