Annick C. Weustink, MD, PhD; Pim J. de Feyter, MD, PhD
Potential Conflicts of Interest: None disclosed.
Weustink AC, de Feyter PJ. Diagnostic Accuracy and Clinical Utility of Noninvasive Testing for Coronary Artery Disease. Ann Intern Med. 2011;154:290. doi: 10.7326/0003-4819-154-4-201102150-00015
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Published: Ann Intern Med. 2011;154(4):290.
The increase of radiation exposure associated with medical imaging studies is concerning and, when possible, should be avoided. In symptomatic patients with a low pretest probability of CAD, negative ECG stress test results—just like a normal contrast-enhanced computed tomographic scan of the coronary arteries—are associated with a very low posttest probability of CAD and do not warrant further downstream testing.
We prefer to use ECG stress testing as an initial study because it is widely available and inexpensive and causes no radiation exposure. If, however, patients with a low pretest probability of CAD have positive ECG stress test results, these results are highly likely to be false-positive.
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