A2 Refereed review article in a scientific journal
ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes Recommendations for cardiovascular imaging
Authors: Saraste Antti, Knuuti Juhani
Publisher: URBAN & VOGEL
Publication year: 2020
Journal: Herz
Journal name in source: HERZ
Journal acronym: HERZ
Volume: 45
Issue: 5
First page : 409
Last page: 420
Number of pages: 10
ISSN: 0340-9937
eISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-020-04935-x
Web address : https://link.springer.com/article/10.1007/s00059-020-04935-x
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/48530152
The European Society of Cardiology (ESC) has recently published new guidelines on the diagnosis and management of chronic coronary syndromes (CCS). Due to variable symptoms, objective tests are often necessary to confirm the diagnosis, exclude alternative diagnoses, and assess the severity of underlying disease. This review provides a summary of the main diagnostic strategies listed in the guidelines for evaluation of patients suspected of having obstructive coronary artery disease (CAD). Based on data from contemporary cohorts of patients referred for diagnostic testing, the pre-test probabilities of obstructive CAD based on age, sex, and symptoms have been adjusted substantially downward compared with the previous guidelines. Further, a new concept of "clinical likelihood of CAD" was introduced accounting for the impact of various risk factors and modifiers on the pre-test probability. Noninvasive functional imaging for myocardial ischemia, coronary computed tomography angiography, or invasive coronary angiography combined with functional evaluation is recommended as the initial strategy to diagnose CAD in symptomatic patients, unless obstructive CAD can be excluded by clinical assessment alone. When available, imaging tests are recommended as noninvasive modalities instead of exercise electrocardiograms.
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