ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons
ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic Heart Disease A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons
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DOI：
10.1016/j.jacc.2013.11.009
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发表时间：
2014-02-04
影响因子：
24
通讯作者：
Brindis, Ralph G.
中科院分区：
文献类型：
--
作者：
Wolk, Michael J.;Brindis, Ralph G.
美国心脏病学院基金会与主要专科和专科学会一起，对稳定性缺血性心脏病(SIHD)的常见临床表现进行了适当的用途审查，以考虑使用负荷测试和解剖诊断程序。本文件反映了针对SIHD的放射性核素显像(RNI)、负荷超声心动图(Echo)、钙化评分、冠状动脉计算机断层扫描(CCTA)、负荷心脏磁共振(CMR)和有创冠状动脉造影术的先前适当使用标准(AUC)的更新。这与经常修订和完善AUC的承诺是一致的。这份文件的一个主要创新是对相同适应症的并排测试进行评级。并排评级消除了人们对每项测试之前使用单独文件导致的指示或解释差异的任何担忧。然而，这些评级显然不是竞争性排名，因为比较证据、患者变异性以及在任何给定的本地环境中可用的能力范围都是有限的。本综述的适应症仅限于SIHD的检测和风险评估，来自常见应用或预期用途，以及当前的临床实践指南。80个临床场景由一个写作委员会开发，并由一个单独的评级小组按1到9的等级进行评分，以指定适当的、可能适当的或很少适当的使用，遵循最近更新的AUC开发方法经过修改的Delphi过程。在具有表现缺血等价物、新诊断的心力衰竭、心律失常和晕厥的症状的患者的初始评估中，使用一些测试方式通常被发现是合适的或可能是合适的，除非测试前概率低或风险低限制了除运动心电图(ECG)外大多数测试的好处。在先前的测试或程序之后，对新的或恶化的症状进行评估的测试被发现是合适的。此外，检测被发现是合适的，或者可能适合于在异常或不确定的先前结果的90天内的患者。术前测试被认为是合适的，或者可能只适用于功能能力较差的患者，这些患者正在接受具有一个或多个临床风险因素的血管或中等风险手术或器官移植。运动心电图被认为是心脏康复清除或运动处方用途的合适测试。无症状患者的测试通常被发现很少适合，除了中危和高危个体的钙评分和运动测试，以及高危个体的负荷或解剖成像，这些都被评为可能合适。在冠状动脉旁路移植术(CABG)后2年内和5年内，在没有新症状的情况下，在先前的测试或经皮冠状动脉介入治疗(PCI)后进行的所有形式的随访测试都很少被认为是合适的。对于功能能力良好的患者，在1年内或在低风险手术之前进行正常测试的患者也很少被发现适合进行术前测试。除了心力衰竭患者的心脏康复许可外，运动处方或开始心脏康复之前的影像检查很少是合适的。
The American College of Cardiology Foundation along with key specialty and subspecialty societies, conducted an appropriate use review of common clinical presentations for stable ischemic heart disease (SIHD) to consider use of stress testing and anatomic diagnostic procedures. This document reflects an updating of the prior Appropriate Use Criteria (AUC) published for radionuclide imaging (RNI), stress echocardiography (Echo), calcium scoring, coronary computed tomography angiography (CCTA), stress cardiac magnetic resonance (CMR), and invasive coronary angiography for SIHD. This is in keeping with the commitment to revise and refine the AUC on a frequent basis. A major innovation in this document is the rating of tests side by side for the same indication. The side-by-side rating removes any concerns about differences in indication or interpretation stemming from prior use of separate documents for each test. However, the ratings were explicitly not competitive rankings due to the limited availability of comparative evidence, patient variability, and range of capabilities available in any given local setting.The indications for this review are limited to the detection and risk assessment of SIHD and were drawn from common applications or anticipated uses, as well as from current clinical practice guidelines. Eighty clinical scenarios were developed by a writing committee and scored by a separate rating panel on a scale of 1 to 9, to designate Appropriate, May Be Appropriate, or Rarely Appropriate use following a modified Delphi process following the recently updated AUC development methodology.The use of some modalities of testing in the initial evaluation of patients with symptoms representing ischemic equivalents, newly diagnosed heart failure, arrhythmias, and syncope was generally found to be Appropriate or May Be Appropriate, except in cases where low pre-test probability or low risk limited the benefit of most testing except exercise electrocardiogram (ECG). Testing for the evaluation of new or worsening symptoms following a prior test or procedure was found to be Appropriate. In addition, testing was found to be Appropriate or May Be Appropriate for patients within 90 days of an abnormal or uncertain prior result. Pre-operative testing was rated Appropriate or May Be Appropriate only for patients who had poor functional capacity and were undergoing vascular or intermediate risk surgery with 1 or more clinical risk factors or an organ transplant. The exercise ECG was suggested as an Appropriate test for cardiac rehabilitation clearance or for exercise prescription purposes.Testing in asymptomatic patients was generally found to be Rarely Appropriate, except for calcium scoring and exercise testing in intermediate and high-risk individuals and either stress or anatomic imaging in higher-risk individuals, which were all rated as May Be Appropriate. All modalities of follow-up testing after a prior test or percutaneous coronary intervention (PCI) within 2 years and within 5 years after coronary artery bypass graft (CABG) in the absence of new symptoms were rated Rarely Appropriate. Pre-operative testing for patients with good functional capacity, prior normal testing within 1 year, or prior to low-risk surgery also were found to be Rarely Appropriate. Imaging for an exercise prescription or prior to the initiation of cardiac rehabilitation was Rarely Appropriate except for cardiac rehabilitation clearance for heart failure patients.