Risks and benefits of cardiac imaging: an analysis of risks related to imaging for coronary artery disease
Risks and benefits of cardiac imaging: an analysis of risks related to imaging for coronary artery disease
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DOI：
10.1093/eurheartj/eht512
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发表时间：
2014-03-01
影响因子：
39.3
通讯作者：
Hesse, Birger
中科院分区：
文献类型：
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作者：
Knuuti, Juhani;Bengel, Frank;Hesse, Birger
与心血管成像(CVI)相关的潜在风险最近引起了争论，部分原因是成像程序和新成像方式(如心脏计算机断层扫描(CT))的使用迅速增加。1、2讨论主要集中在单一风险方面，如辐射。然而，各种程序都有几个风险：应激源、造影剂、侵入性、辐射等。更重要的是，测试必须与执行或不执行测试的好处相关，而与疾病相关的风险和缺陷仍未被检测到。我们的目标是建立与冠状动脉疾病(CAD)自然病程和治疗干预相关的与CVI相关的直接、短期和长期风险的平衡分析。由于许多CVI检查是常用的，所以选择了用于CAD的影像检查。我们分析了：(I)成像测试每个组成部分的重大心脏事件(MCE)的风险；(Ii)每个风险的上限，以避免低估风险；(Iii)为选定的CAD常见诊断测试计算的综合风险；(Iv)与疾病本身的风险比较，以评估测试的潜在益处；以及(V)与日常生活活动中的风险和与使用阿司匹林等微不足道的长期预防性干预相关的风险的比较。这一分析是基于从文献中获得的数据。与某些程序相关的风险数据是相当有限的，对于一些变量，对于一些有限的质量。尽管如此，我们还是试图使用可靠的研究和数据库，通过对文献的广泛搜索，提出所有程序的风险估计。这个
The potential risks associated with cardiovascular imaging (CVI) have recently been debated, partly triggered by the rapid increase in the use of imaging procedures and new imaging modalities such as cardiac computed tomography (CT). 1, 2 The discussion has mainly focused only on a single-risk aspect such as radiation. 3 However, the various procedures have several risks: stressors, contrast agents, invasiveness, radiation, etc. Even more important, the test must be related to the benefit of performing or not performing the test with the risk and drawbacks associated with the disease remaining undetected.We aimed to create a balanced analysis of immediate, short-and long-term risks associated with CVI in relation to the natural course of coronary artery disease (CAD) and to therapeutic interventions. The imaging tests for CAD were selected, since many CVI tests are commonly used. We analysed:(i) the risk of major cardiac events (MCEs) for each component of imaging test;(ii) the upper limit for each risk, in order to avoid underestimation of a risk;(iii) composite risks calculated for selected common diagnostic tests for CAD;(iv) the risks compared with the risk of the disease itself, to assess the potential benefits of tests; and (v) comparison with risks in regular life activities and that associated with trivial longterm prophylactic interventions such as aspirin use. This analysis is based on the data available from the literature. Data for risks related to some of the procedures are quite limited, for some variable, and for some of limited quality. Still we sought to present risk estimations from all the procedures using reliable studies and databases available from an extensive search of the literature. The