Diagnostic Implications in the Aftermath of the ISCHEMIA Trial

The American Journal of Cardiology
G B John Mancini, William E Boden

Abstract

The recently reported ISCHEMIA trial will reignite the debate regarding the optimal first diagnostic test when evaluating chest pain in patients suspected to have coronary artery disease. This article considers whether the debate should be refocused even before selecting any diagnostic test. The case is made to prioritize risk factor management and empiric angina pectoris control as part of optimal secondary prevention followed by expeditious clinical reassessment to determine adequacy of therapeutic responses, including quality of life, before embarking on diagnostic testing. Once anatomical coronary artery disease is known in diagnostic algorithms that incorporate cardiac computed tomographic angiography, there is the potential to forego an adequate trial of conservative management, thereby failing to translate the key finding of ISCHEMIA to practice. Embedded in this "Symptom-driven Path" is the principle that definitive diagnostic testing must be expeditious if symptoms persist or deteriorate and impair quality of life during conservative management. This strategy would ensure appropriate utilization of contemporary conservative management which is replete with numerous effective pharmacotherapies that modify atherosclerosi...Continue Reading

Citations

Jun 8, 2021·Circulation. Cardiovascular Interventions·Nadia R SuttonRoger S Blumenthal

❮ Previous
Next ❯

Related Concepts

Related Feeds

Cardiovascular Diseases: Risk Factors

Cardiovascular disease is a significant health concern. Risk factors include hypertension, obesity, dyslipidemia and smoking. Women who are postmenopausal are at an increased risk of heart disease. Here is the latest research for risk factors of cardiovascular disease.