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Diagnostic Performance and Comparative Cost-Effectiveness of Non-invasive Imaging Tests in Patients Presenting with Chronic Stable Chest Pain with Suspected Coronary Artery Disease: A Systematic Overview

  • Cardiac PET, CT, and MRI (SE Petersen, Section Editor)
  • Published:
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Abstract

Several non-invasive imaging techniques are currently in use for the diagnostic workup of adult patients with stable chest pain suspected of having coronary artery disease (CAD). In this paper, we present a systematic overview of the evidence on diagnostic performance and comparative cost-effectiveness of new modalities in comparison to established technologies. A literature search for English language studies from 2009 to 2013 was performed, and two investigators independently extracted data on patient and study characteristics. The reviewed published evidence on diagnostic performance and cost-effectiveness support a strategy of CTCA as a rule out (gatekeeper) test of CAD in low- to intermediate-risk patients since it has excellent diagnostic performance and as initial imaging test is cost-effective under different willingness-to-pay thresholds. More cost-effectiveness research is needed in order to define the role and choice of cardiac stress imaging tests.

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Abbreviations

CAD:

Coronary artery disease

CAG:

Catheter-based (invasive) coronary angiography

CMR:

Cardiac magnetic resonance imaging

CTCA:

CT coronary angiography

FFR:

Fractional flow reserve

MRI:

Magnetic resonance imaging

MPI:

Myocardial perfusion imaging

MPS:

Myocardial perfusion spectroscopy

PET:

Positron emission tomography

QALY:

Quality-adjusted life year

SE:

Stress echocardiography

SPECT:

Single photon emission computed tomography

XECG:

Stress electrocardiography

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Compliance with Ethics Guidelines

Conflict of Interest

Claudia N. van Waardhuizen, Marieke Langhout, Felisia Ly, Loes Braun, Tessa S.S. Genders, Kirsten E. Fleischmann and Koen Nieman declare that they have no conflict of interest.

Steffen E. Petersen has been a consultant to Circle Cardiovascular Imaging Inc., Calgary, Canada.

M. G. Myriam Hunink reports royalties from Cambridge University Press, travel reimbursement and grants from European Society of Radiology (ESR) and travel reimbursement and Member of Scientific Advisory Board from European Institute for Biomedical Imaging Research.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Epidemiology, Erasmus University Medical Center, Internal postal address Na2818, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands

    Claudia N. van Waardhuizen, Marieke Langhout, Felisia Ly, Loes Braun, Tessa S. S. Genders & M. G. Myriam Hunink

  2. Department of Radiology, Erasmus University Medical Center, Internal postal address Na2818, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands

    Claudia N. van Waardhuizen, Marieke Langhout, Felisia Ly, Loes Braun, Tessa S. S. Genders & M. G. Myriam Hunink

  3. Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Queen Mary University of London, Bethnal Green, London, E2 9JX, UK

    Steffen E. Petersen

  4. Division of Cardiology, UCSF Medical Center, 505 Parnassus Ave, P.O. Box 0124, San Francisco, CA, 94143-0124, USA

    Kirsten E. Fleischmann

  5. Department of Cardiology, Erasmus University Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands

    Koen Nieman

  6. Department of Health Decision Sciences, Harvard School of Public Health, Harvard University, Boston, MA, USA

    M. G. Myriam Hunink

  7. Department of Tertiary care, Quality, Audits and Finance, Association of Tertiary Medical Teaching Hospitals (STZ), P.O. Box 9696, 3506, GR, Utrecht, The Netherlands

    Claudia N. van Waardhuizen

Authors
  1. Claudia N. van Waardhuizen
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  2. Marieke Langhout
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  3. Felisia Ly
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  4. Loes Braun
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  5. Tessa S. S. Genders
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  6. Steffen E. Petersen
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  7. Kirsten E. Fleischmann
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  8. Koen Nieman
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  9. M. G. Myriam Hunink
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Corresponding author

Correspondence to M. G. Myriam Hunink.

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This article is part of the Topical Collection on Cardiac PET CT, and MRI

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van Waardhuizen, C.N., Langhout, M., Ly, F. et al. Diagnostic Performance and Comparative Cost-Effectiveness of Non-invasive Imaging Tests in Patients Presenting with Chronic Stable Chest Pain with Suspected Coronary Artery Disease: A Systematic Overview. Curr Cardiol Rep 16, 537 (2014). https://doi.org/10.1007/s11886-014-0537-9

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  • DOI: https://doi.org/10.1007/s11886-014-0537-9

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