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ESC 2019 guidelines for the diagnosis and management of chronic coronary syndromes Recommendations for cardiovascular imaging

机译：Esc 2019慢性冠状动脉综合征慢性冠状动脉综合征的诊断和管理指导方针的心血管成像建议

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摘要

The European Society of Cardiology (ESC) has recently published new guidelines on the diagnosis and management of chronic coronary syndromes (CCS). Due to variable symptoms, objective tests are often necessary to confirm the diagnosis, exclude alternative diagnoses, and assess the severity of underlying disease. This review provides a summary of the main diagnostic strategies listed in the guidelines for evaluation of patients suspected of having obstructive coronary artery disease (CAD). Based on data from contemporary cohorts of patients referred for diagnostic testing, the pre-test probabilities of obstructive CAD based on age, sex, and symptoms have been adjusted substantially downward compared with the previous guidelines. Further, a new concept of "clinical likelihood of CAD" was introduced accounting for the impact of various risk factors and modifiers on the pre-test probability. Noninvasive functional imaging for myocardial ischemia, coronary computed tomography angiography, or invasive coronary angiography combined with functional evaluation is recommended as the initial strategy to diagnose CAD in symptomatic patients, unless obstructive CAD can be excluded by clinical assessment alone. When available, imaging tests are recommended as noninvasive modalities instead of exercise electrocardiograms.
机译：欧洲心脏病学会（ESC）最近发表了关于慢性冠状动脉综合征（CCS）的诊断和管理的新准则。由于可变症状，客观测试通常需要确认诊断，不含替代诊断，并评估潜在疾病的严重程度。本综述概述了涉嫌患有阻塞性冠状动脉疾病（CAD）的患者的评估指南中列出的主要诊断策略摘要。根据来自诊断测试患者的当代队列的数据，与前一项指南相比，基于年龄，性别和症状的阻塞性CAD的预测概率已经基本上向下调整。此外，引入了“CAD的临床可能性”的新概念，概述了各种风险因素和改性剂对预测试概率的影响。对于心肌缺血，冠状动脉计算断层造影血管造影或侵袭性冠状动脉造影或侵袭性冠状动脉造影结合功能评估的非侵入性功能成像被推荐作为症状患者诊断CAD的初始策略，除非阻塞性CAD可以单独被临床评估排除。当可用时，建议成像测试作为非侵入方式而不是运动心电图。

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