edoc

Gate-keeper to coronary angiography : comparison of exercise testing, myocardial perfusion SPECT and individually tailored approach for risk stratification

Muzzarelli, Stefano and Pfisterer, Matthias Emil and Müller-Brand, Jan and Zellweger, Michael Johannes. (2010) Gate-keeper to coronary angiography : comparison of exercise testing, myocardial perfusion SPECT and individually tailored approach for risk stratification. The international journal of cardiovascular imaging, Vol. 26, H. 8. pp. 871-879.

Full text not available from this repository.

Official URL: http://edoc.unibas.ch/dok/A6006852

Downloads: Statistics Overview

Abstract

We aimed to evaluate the differences between exercise testing (ET), myocardial perfusion SPECT (MPS) and a combination of ET and MPS based risk assessment as outlined by the guidelines with respect to their "gate-keeper" role to coronary angiography (cath) and the associated diagnostic procedural costs if prognostic considerations, as those proposed by the current guidelines and the recent literature, were taken into account. The Duke-score and the summed difference score (SDS; extent of ischemia) were assessed in 955 consecutive patients referred for MPS combined with ET. According to the guidelines and the available literature, three different algorithms for risk stratification were retrospectively applied: (1) ET based risk stratification and cath if intermediate or high risk Duke-score; (2) MPS based risk stratification and cath if SDS 8; (3) combined approach with ET as first step and MPS in case of intermediate risk Duke-score. A cath would have been suggested in every patient with either high risk Duke-score or SDS 8 in patients with intermediate risk Duke-score. The referral rate to cath was 27% according to the ET alone, 13% using MPS, and finally 12% applying the combined risk stratification. The cost of the diagnostic work-up including cath were: 615 , 1,299 , and 598 per patient, respectively. The coronary angiography referral rate widely depends on the diagnostic modality used for risk stratification and according to the referral criteria provided by the guidelines. In the present study, the use of a stress imaging modality (MPS) and published prognostic data was associated with a lower referral rate to cath as compared to exercise testing alone and thus underlines the advantage of a risk based approach applying stress imaging in patients with intermediate risk Duke-score.
Faculties and Departments:03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Kardiologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Kardiologie
UniBasel Contributors:Zellweger, Michael J.
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:Springer
ISSN:1573-0743
Note:Publication type according to Uni Basel Research Database: Journal article
Related URLs:
Identification Number:
Last Modified:19 Jul 2013 07:43
Deposited On:19 Jul 2013 07:35

Repository Staff Only: item control page