Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Outros Autores: | , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | International Journal of Cardiovascular Sciences (Online) |
Texto Completo: | http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472017000600526 |
Resumo: | Abstract Patients with intermediate probability of coronary disease are a diagnostic challenge and it is precisely in this population where the degree of uncertainty is greater that the diagnostic tests have their greater applicability. However, according to the current definition, subjecting to tests a population with a disease probability between 10 and 90% can generate unnecessary tests and misleading results. Knowing the characteristics of each test, as well as risks and benefits of drug treatment for coronary disease and combining this information through diagnostic thresholds brings a new perspective to decision making. To review the origin of the currently recommended concepts of intermediate probability and to determine the thresholds for diagnosis and treatment of noninvasive tests and, based on them, propose a new concept of intermediate probability of coronary disease. Through the bibliographic review, meta-analyses were extracted in which data of sensitivity, specificity, positive and negative likelihood ratio, risks and benefits of the tests and treatment were provided. Using an algorithm developed by Pauker et al. it was possible to obtain the diagnostic and treatment thresholds adjusted for each tests in question. The concept of intermediate probability of coronary disease is quite broad, ranging, according to the authors, between 10 and 90%, 1 and 92%, 15 and 85%, with different rationale. Considering the discriminatory power of each test, risks and treatment benefits, the diagnostic and treatment thresholds were defined for exercise testing (22-58%), eco-stress (10-72%), myocardial scintigraphy (12-80%), nuclear magnetic resonance (16-80%) and coronary angiotomography (6.7-81%). The decision to submit to diagnostic tests should be individualized, taking into account the diagnostic and treatment thresholds of each method in question. |
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Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making AnalysisCoronary Artery DiseaseProbabilityClinical Decision-MakingDiagnosisMeta-AnalysisAbstract Patients with intermediate probability of coronary disease are a diagnostic challenge and it is precisely in this population where the degree of uncertainty is greater that the diagnostic tests have their greater applicability. However, according to the current definition, subjecting to tests a population with a disease probability between 10 and 90% can generate unnecessary tests and misleading results. Knowing the characteristics of each test, as well as risks and benefits of drug treatment for coronary disease and combining this information through diagnostic thresholds brings a new perspective to decision making. To review the origin of the currently recommended concepts of intermediate probability and to determine the thresholds for diagnosis and treatment of noninvasive tests and, based on them, propose a new concept of intermediate probability of coronary disease. Through the bibliographic review, meta-analyses were extracted in which data of sensitivity, specificity, positive and negative likelihood ratio, risks and benefits of the tests and treatment were provided. Using an algorithm developed by Pauker et al. it was possible to obtain the diagnostic and treatment thresholds adjusted for each tests in question. The concept of intermediate probability of coronary disease is quite broad, ranging, according to the authors, between 10 and 90%, 1 and 92%, 15 and 85%, with different rationale. Considering the discriminatory power of each test, risks and treatment benefits, the diagnostic and treatment thresholds were defined for exercise testing (22-58%), eco-stress (10-72%), myocardial scintigraphy (12-80%), nuclear magnetic resonance (16-80%) and coronary angiotomography (6.7-81%). The decision to submit to diagnostic tests should be individualized, taking into account the diagnostic and treatment thresholds of each method in question.Sociedade Brasileira de Cardiologia2017-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472017000600526International Journal of Cardiovascular Sciences v.30 n.6 2017reponame:International Journal of Cardiovascular Sciences (Online)instname:Sociedade Brasileira de Cardiologia (SBC)instacron:SBC10.5935/2359-4802.20170071info:eu-repo/semantics/openAccessThiers,Clarissa AntunesBarbosa,João LuisTura,Bernardo RangelArruda,Edilson FernandesPereira,Basilio de Bragançaeng2017-11-27T00:00:00Zoai:scielo:S2359-56472017000600526Revistahttp://publicacoes.cardiol.br/portal/ijcshttps://old.scielo.br/oai/scielo-oai.phptailanerodrigues@cardiol.br||revistaijcs@cardiol.br2359-56472359-4802opendoar:2017-11-27T00:00International Journal of Cardiovascular Sciences (Online) - Sociedade Brasileira de Cardiologia (SBC)false |
dc.title.none.fl_str_mv |
Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis |
title |
Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis |
spellingShingle |
Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis Thiers,Clarissa Antunes Coronary Artery Disease Probability Clinical Decision-Making Diagnosis Meta-Analysis |
title_short |
Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis |
title_full |
Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis |
title_fullStr |
Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis |
title_full_unstemmed |
Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis |
title_sort |
Performance of Diagnostic Tests for Intermediate Probabilities of Coronary Heart Disease: A Decision Making Analysis |
author |
Thiers,Clarissa Antunes |
author_facet |
Thiers,Clarissa Antunes Barbosa,João Luis Tura,Bernardo Rangel Arruda,Edilson Fernandes Pereira,Basilio de Bragança |
author_role |
author |
author2 |
Barbosa,João Luis Tura,Bernardo Rangel Arruda,Edilson Fernandes Pereira,Basilio de Bragança |
author2_role |
author author author author |
dc.contributor.author.fl_str_mv |
Thiers,Clarissa Antunes Barbosa,João Luis Tura,Bernardo Rangel Arruda,Edilson Fernandes Pereira,Basilio de Bragança |
dc.subject.por.fl_str_mv |
Coronary Artery Disease Probability Clinical Decision-Making Diagnosis Meta-Analysis |
topic |
Coronary Artery Disease Probability Clinical Decision-Making Diagnosis Meta-Analysis |
description |
Abstract Patients with intermediate probability of coronary disease are a diagnostic challenge and it is precisely in this population where the degree of uncertainty is greater that the diagnostic tests have their greater applicability. However, according to the current definition, subjecting to tests a population with a disease probability between 10 and 90% can generate unnecessary tests and misleading results. Knowing the characteristics of each test, as well as risks and benefits of drug treatment for coronary disease and combining this information through diagnostic thresholds brings a new perspective to decision making. To review the origin of the currently recommended concepts of intermediate probability and to determine the thresholds for diagnosis and treatment of noninvasive tests and, based on them, propose a new concept of intermediate probability of coronary disease. Through the bibliographic review, meta-analyses were extracted in which data of sensitivity, specificity, positive and negative likelihood ratio, risks and benefits of the tests and treatment were provided. Using an algorithm developed by Pauker et al. it was possible to obtain the diagnostic and treatment thresholds adjusted for each tests in question. The concept of intermediate probability of coronary disease is quite broad, ranging, according to the authors, between 10 and 90%, 1 and 92%, 15 and 85%, with different rationale. Considering the discriminatory power of each test, risks and treatment benefits, the diagnostic and treatment thresholds were defined for exercise testing (22-58%), eco-stress (10-72%), myocardial scintigraphy (12-80%), nuclear magnetic resonance (16-80%) and coronary angiotomography (6.7-81%). The decision to submit to diagnostic tests should be individualized, taking into account the diagnostic and treatment thresholds of each method in question. |
publishDate |
2017 |
dc.date.none.fl_str_mv |
2017-12-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472017000600526 |
url |
http://old.scielo.br/scielo.php?script=sci_arttext&pid=S2359-56472017000600526 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
10.5935/2359-4802.20170071 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia |
publisher.none.fl_str_mv |
Sociedade Brasileira de Cardiologia |
dc.source.none.fl_str_mv |
International Journal of Cardiovascular Sciences v.30 n.6 2017 reponame:International Journal of Cardiovascular Sciences (Online) instname:Sociedade Brasileira de Cardiologia (SBC) instacron:SBC |
instname_str |
Sociedade Brasileira de Cardiologia (SBC) |
instacron_str |
SBC |
institution |
SBC |
reponame_str |
International Journal of Cardiovascular Sciences (Online) |
collection |
International Journal of Cardiovascular Sciences (Online) |
repository.name.fl_str_mv |
International Journal of Cardiovascular Sciences (Online) - Sociedade Brasileira de Cardiologia (SBC) |
repository.mail.fl_str_mv |
tailanerodrigues@cardiol.br||revistaijcs@cardiol.br |
_version_ |
1754732624838918144 |