Almanac 2011

EDiToRiAL Stable angina pectoriS Diagnostic strategiesThe widespread application of specialist clinics for early evaluation of patients with chest pain has focused attention on the effectiveness of diagnostic testing.In a study of nearly 400 000 patients with suspected coronary artery disease, the diagnostic yield of cardiac catheterisation was only 37.6%, leading to calls for better strategies for risk stratification. 1 As pointed out in correspondence, the low yield was probably due to verification bias, itself a consequence of basing referral decisions in low-risk populations on noninvasive tests such as exercise ECG. 2 Similar considerations prompted the NICE guideline group to recommend a more selective approach to non-invasive testing based on a careful clinical assessment of disease probability in patients presenting with stable chest pain. 3For those, with unequivocal histories at the extremes of diagnostic probability ( 90%) no diagnostic tests were considered necessary, while for patients with a high probability of disease (60-90%) invasive angiography without prior ischaemia testing was recommended.The NICE call for CT calcium scoring in patients with a low (10-30%) probability of disease generated greatest concern, particularly after a report that 19% of patients without coronary calcification-who would have been ruled out for angina in the NICE algorithm-had obstructive (>50% stenosis) disease. 4However, the population referred for angiography in this study had a high pre-test probability of disease and in lower-risk populations CT calcium scoring retains a high diagnostic sensitivity. 5NICE recommendations were driven largely by cost-effectiveness analysis but whether they will improve the diagnostic yield of cardiac catheterisation remains to be seen. Medical treatment of anginaThe medical treatment of angina has been the subject of renewed interest, because of the availability of new treat

Angina · Cardiology · Chest pain · Coronary angiography · Coronary artery disease · Disease · Fractional flow reserve · Guideline · Myocardial infarction · Nice · Pathology · Population · Pre- and post-test probability · Radiology · Acute Myocardial Infarction Research · Cardiac Imaging and Diagnostics · Coronary Interventions and Diagnostics · Medicine · Internal Medicine