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Updated: Nov 19, 2025

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
06:16

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

Published on: August 9, 2024

657

Patient first versus computed tomography first strategy in testing for stable coronary artery disease: dispelling the

Edward A Hulten1,2,3, Saurabh Malhotra4,5, Suman Tandon6

  • 1Departments of Medicine, Cardiology Service, Fort Belvoir Community Hospital, DeWitt Loop 9300, Fort Belvoir, VA, 22060, USA. eddiehulten@gmail.com.

Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
|January 29, 2021
PubMed

Insights

We advocate for a patient-first approach to diagnosing stable ischemic heart disease, prioritizing individual needs over specific imaging tests. Evidence supports personalized strategies for the right test for the right patient, not a one-size-fits-all modality.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Evidence-Based Medicine

Background:

  • Stable ischemic heart disease evaluation involves numerous diagnostic tests.
  • Traditional guidelines emphasize functional testing for diagnosis and prognosis.
  • Industry trends promote modality-specific strategies like CT-first for coronary artery disease (CAD).

Discussion:

  • This review critically examines the evidence for patient-first versus modality-specific diagnostic strategies.
  • It highlights the limitations of a universal "CT-first" approach for stable CAD.
  • The discussion emphasizes tailoring diagnostic pathways to individual patient characteristics and clinical presentation.

Key Insights:

  • A patient-first philosophy ensures the most appropriate diagnostic test is selected for each individual.
  • Current evidence does not universally support a "CT-first" approach for all patients with suspected stable CAD.
  • Personalized assessment is crucial for effective diagnosis, prognosis, and management of ischemic heart disease.

Outlook:

  • Future research should focus on comparative effectiveness of patient-centered diagnostic strategies.
  • Guidelines should continue to evolve, prioritizing individualized patient care in stable ischemic heart disease.
  • Promoting shared decision-making between clinicians and patients regarding diagnostic testing is essential.

Keywords:
CAD < Diseases/processesCT < ModalitiesEcho < ModalitiesMPI < TestsPET < ModalitiesSPECT < Modalities

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