Chronic stable angina assessing the pretest probability of coronary artery disease: Difference between revisions
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====Definition==== | ====Definition==== | ||
Pretest Probability is defined as the probability of the target disorder before the result of a diagnostic test is known. The pretest probability is especially useful for: | Pretest Probability is defined as the probability of the target disorder before the result of a diagnostic test is known. The pretest probability is especially useful for: | ||
* deciding whether its worth testing at all(test threshold) | |||
* selecting type of diagnostic test | |||
* interpreting the results of a diagnostic test | |||
* choosing whether to start therapy: | |||
a)without futher testing(treatment threshold); | |||
b)while awaiting further testing | |||
====Calculating the pretest probability for | ====Calculating the pretest probability for coronary artery disease==== | ||
First step is to categorize the type of chest pain or discomfort. This can be done as follows: | First step is to categorize the type of chest pain or discomfort. This can be done as follows: | ||
* Typical angina(definite) | |||
# substernal chest discomfort with chracteristic quality and duration | |||
# provoked by exercise or emotional stress | |||
# relieved by rest or[[NTG]] | |||
* Atypical angina(probable)-meets 2 of the above criteria | * Atypical angina(probable)-meets 2 of the above criteria | ||
* Nonanginal pain- meets one or zero of the anginal characteristics. | * Nonanginal pain- meets one or zero of the anginal characteristics. | ||
Next step is to calculate the pretest probability of CAD based on age, gender and type of pain. | Next step is to calculate the pretest probability of CAD based on age, gender and type of pain. |
Revision as of 18:10, 27 August 2009
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-in-Chief: Smita Kohli, M.D.
Overview
Once the history and physical examination is complete, it is important to assess the probability of coronary artery disease as this helps both the physician and the patient to decide what next step in diagnosis and treatment should be taken. There have been a lot of studies emphasizing the importance of assessing pretest probability of CAD for every patient. Diamond and Forrester[1] showed in their study that age, gender and type of pain are strong predictors for the likelihood of CAD. Multiple subsequent prospective studies have confirmed their conclusion.
Pretest Probability
Definition
Pretest Probability is defined as the probability of the target disorder before the result of a diagnostic test is known. The pretest probability is especially useful for:
- deciding whether its worth testing at all(test threshold)
- selecting type of diagnostic test
- interpreting the results of a diagnostic test
- choosing whether to start therapy:
a)without futher testing(treatment threshold); b)while awaiting further testing
Calculating the pretest probability for coronary artery disease
First step is to categorize the type of chest pain or discomfort. This can be done as follows:
- Typical angina(definite)
- substernal chest discomfort with chracteristic quality and duration
- provoked by exercise or emotional stress
- relieved by rest orNTG
- Atypical angina(probable)-meets 2 of the above criteria
- Nonanginal pain- meets one or zero of the anginal characteristics.
Next step is to calculate the pretest probability of CAD based on age, gender and type of pain.
- ↑ Improved interpretation of a continuous variable in diagnostic testing: probabilistic analysis of scintigraphic rest and exercise left ventricular ejection fractions for coronary disease detection. Diamond GA, Forrester JS. Am Heart J. 1981 Aug;102(2):189-95. PMID: 7258092