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
复制标题
DOI：
10.1016/j.cardfail.2013.12.002
复制
发表时间：
2014-02-01
影响因子：
6
通讯作者：
Allen, Joseph M.
中科院分区：
文献类型：
--
作者：
Wolk, Michael J.;Bailey, Steven R.;Allen, Joseph M.
美国心脏病学会基金会与主要专业和亚专业协会一起对稳定型缺血性心脏病 (SIHD) 的常见临床表现进行了适当的使用审查，以考虑使用压力测试和解剖诊断程序。本文件反映了先前发布的放射性核素成像 (RNI)、负荷超声心动图 (Echo)、钙评分、冠状动脉计算机断层扫描血管造影 (CCTA)、负荷心脏磁共振 (CMR) 和 SIHD 侵入性冠状动脉造影的适当使用标准 (AUC) 的更新。这符合频繁修改和完善 AUC 的承诺。本文件的一项主要创新是对同一适应症的并排测试进行评级。并排评级消除了由于之前对每个测试使用单独的文件而导致的指示或解释差异的任何担忧。然而，由于比较证据的可用性、患者的变异性以及任何特定当地环境中可用的能力范围有限，这些评级显然不是竞争性排名。本次审查的适应症仅限于 SIHD 的检测和风险评估，并来自常见应用或预期用途以及当前的临床实践指南。编写委员会制定了 80 个临床场景，并由单独的评级小组按照 1 至 9 的等级进行评分，以根据最近更新的 AUC 开发方法，经过修改的 Delphi 流程来指定适当、可能适当或很少适当的使用。在对具有缺血等价物、新诊断的心力衰竭、心律失常和晕厥症状的患者进行初步评估时，通常认为使用某些测试方式是适当的或适当的 可能是适当的，除非测试前概率低或风险低限制了除运动心电图 (ECG) 之外的大多数测试的益处。在先前的测试或程序之后进行测试以评估新的或恶化的症状被认为是适当的。此外，在先前结果异常或不确定的 90 天内，对患者进行测试被认为是适当或可能适当的。仅对于功能较差且正在接受具有 1 种或多种临床危险因素的血管或中度风险手术或器官移植的患者，术前测试才被评为“适当”或“可能适当”。运动心电图被建议作为心脏康复清除或运动处方目的的适当测试。无症状患者的测试通常被认为是很少适当的，除了中度和高风险个体的钙评分和运动测试以及高风险个体的压力或解剖成像，这些都被评为可能适当。在没有新症状的情况下，在先前测试或经皮冠状动脉介入治疗 (PCI) 后 2 年内以及冠状动脉旁路移植 (CAB G) 后 5 年内进行的所有后续测试方式均被评为“很少合适”。对于功能良好的患者、1 年内之前的正常测试或低风险手术之前进行的术前测试也被发现是很少合适的。除心力衰竭患者的心脏康复清除外，很少适合在运动处方或开始心脏康复之前进行影像学检查。
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 (CAB G) 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.