PMC:2940023 / 27219-29435
Annnotations
{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/2940023","sourcedb":"PMC","sourceid":"2940023","source_url":"https://www.ncbi.nlm.nih.gov/pmc/2940023","text":"Clinical implications\nOur results demonstrate that the estimation of the probability of obstructive CAD can be improved by including CTCS. This implies that clinicians can make better decisions as to whether a particular patient would benefit from further testing, for example CTCA or CCA. In low-risk patients, a CTCS of 0 could exclude CAD and avoid further testing using CTCA. Hereby, one also avoids the intravenous administration of contrast agent, the extra radiation exposure, and extra scan time and costs associated with CTCA. In patients with a low CTCS, CCA can be avoided and further non-invasive testing would be preferred. In patients with an intermediate CTCS, a CTCA might be the optimal next step. In patients with a high CTCS, direct CCA might be justified because of the high probability of CAD. All in all, CTCS could be useful as a triage test for patients who are suspected of having CAD.\nWe confirmed that the prediction of significant CAD is primarily driven by the patient’s symptoms. A detailed history of the patient’s symptoms remains most important in the diagnostic work-up of patients with suspected CAD. However, history taking is difficult and subjective, therefore limiting our ability to accurately predict the presence of CAD. Hence, further diagnostic testing will be important, even in patients with a low to intermediate probability of CAD.\nOn the other hand, the harms and costs of obtaining CTCS should be considered. Kim [27] studied the radiation dose and cancer risk of CTCS screening (every 5 years) in asymptomatic individuals. They concluded that the excess lifetime cancer risk was 42 (62) per 100,000 men (women). It is important to note that our study assessed the value of a single CTCS in symptomatic patients, for whom the excess lifetime cancer risk will be lower and small compared with the risk of missing a CAD diagnosis. Moreover, CTCS could reduce the use of additional testing in patients with a low CTCS and a low probability of CAD, thereby reducing the total radiation exposure.\nAlthough performing a CTCS measurement is a fast, low-dose and relatively inexpensive procedure, the harms and benefits should be considered in a cost-effectiveness analysis.","divisions":[{"label":"title","span":{"begin":0,"end":21}},{"label":"p","span":{"begin":22,"end":910}},{"label":"p","span":{"begin":911,"end":1379}},{"label":"p","span":{"begin":1380,"end":2041}}],"tracks":[{"project":"0_colil","denotations":[{"id":"20559838-19597067-57208","span":{"begin":1464,"end":1466},"obj":"19597067"}],"attributes":[{"subj":"20559838-19597067-57208","pred":"source","obj":"0_colil"}]},{"project":"2_test","denotations":[{"id":"20559838-19597067-29364910","span":{"begin":1464,"end":1466},"obj":"19597067"}],"attributes":[{"subj":"20559838-19597067-29364910","pred":"source","obj":"2_test"}]},{"project":"TEST0","denotations":[{"id":"20559838-84-90-57208","span":{"begin":1464,"end":1466},"obj":"[\"19597067\"]"}],"attributes":[{"subj":"20559838-84-90-57208","pred":"source","obj":"TEST0"}]},{"project":"MyTest","denotations":[{"id":"20559838-19597067-29364910","span":{"begin":1464,"end":1466},"obj":"19597067"}],"namespaces":[{"prefix":"_base","uri":"https://www.uniprot.org/uniprot/testbase"},{"prefix":"UniProtKB","uri":"https://www.uniprot.org/uniprot/"},{"prefix":"uniprot","uri":"https://www.uniprot.org/uniprotkb/"}],"attributes":[{"subj":"20559838-19597067-29364910","pred":"source","obj":"MyTest"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"0_colil","color":"#be93ec","default":true},{"id":"2_test","color":"#93eca4"},{"id":"TEST0","color":"#ec939b"},{"id":"MyTest","color":"#93b5ec"}]}]}}