Diagnosis

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Normal Lab Values

The first step in the diagnosis of CAD is to estimate the pretest probability based on known cardiovascular risk factors and symptoms. A simple estimate of the pretest probability of CAD based on age, gender, and symptoms is as follows (9):

Low (<10%):

  • Asymptomatic men and women of all ages
  • Women younger than 50 years with atypical angina

Intermediate (10%–90%):

  • Men of all ages with atypical angina
  • Women 50 years or older with atypical angina
  • Women 30 to 59 years of age with typical angina

High (>90%):

  • Men 40 years or older with typical angina
  • Women 60 years or older with typical angina

Noninvasive stress tests for detecting CAD perform best in patients with an intermediate pretest probability of disease. In patients with a high pretest probability of disease, a negative test result is most likely to be falsely negative. In that setting, coronary angiography may be required. In patients with a low pretest probability, a positive stress test result is likely to be falsely positive.

9. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol. 2002;40:1531-40. [PMID: 12392846]
10. Lodge MA, Braess H, Mahmoud F, Suh J, Englar N, Geyser-Stoops S, et al. Developments in nuclear cardiology: transition from single photon emission computed tomography to positron emission tomography-computed tomography.J Invasive Cardiol. 2005;17:491-6. [PMID: 16145241]
11. Keelan PC, Bielak LF, Ashai K, Jamjoum LS, Denktas AE, Rumberger JA, et al. Long-term prognostic value of coronary calcification detected by electron-beam computed tomography in patients undergoing coronary angiography. Circulation. 2001;104:412-7. [PMID: 11468202]
12. O’Rourke RA, Brundage BH, Froelicher VF, Greenland P, Grundy SM, Hachamovitch R, et al. American College of Cardiology/American Heart Association Expert Consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. Circulation. 2000;102:126-40. [PMID: 10880426]

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