Noninvasive testing in coronary artery disease. Selection of procedures and interpretation of results

Area of Science:

• Cardiology
• Diagnostic Medicine

Background:

• Critical decisions in acute and chronic chest pain management require effective diagnostic strategies.
• Current empirical guidelines assist in test selection and patient disposition.

Purpose of the Study:

• To outline useful empirical guidelines for diagnosing chest pain.
• To differentiate diagnostic test selection based on patient presentation and pain characteristics.

Main Methods:

• Review of empirical guidelines for chest pain evaluation.
• Analysis of diagnostic test utility in acute and chronic chest pain scenarios.
• Consideration of patient factors like gender and pain character in test selection.

Main Results:

• Serum creatine kinase MB fraction is valuable for hospitalized patients with suspected infarction and nondiagnostic ECGs.
• Myocardial scintiscan shows greater accuracy than exercise ECG in women and men with nonanginal chest pain.
• For men with typical angina, coronary artery disease is highly probable, often negating the need for diagnostic tests.

Conclusions:

• Diagnostic test selection for chest pain should be guided by patient history, pain characteristics, and gender.
• Specific biomarkers and imaging techniques offer differential diagnostic value.
• In many cases, particularly typical angina in men, extensive diagnostic testing may be unnecessary.