Considerations in the selection of noninvasive testing for the diagnosis of coronary artery disease
In selecting a noninvasive test for the assessment of patients with suspected coronary artery disease, the clinician must choose from a growing number of methods that use various types of stress and markers of ischemia. Noninvasive testing is most valuable in patients with an intermediate pretest likelihood of disease based on clinical history and risk factors. In patients who are able to exercise, this form of stress is optimal, whereas pharmacologic stress testing can be performed in those who are unable to exercise adequately. Imaging studies, including two-dimensional echocardiography and nuclear scintigraphy, increase the accuracy of noninvasive tests in the diagnosis of coronary artery disease and are essential in pharmacologic stress studies. Ultimately, the selection of an appropriate test depends on multiple factors, which can be considered in a sequential fashion.
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