Download the full report (116 p.) - KCE

More documents

Recommendations

Info

36 Multislice CT in Coronary Heart Disease KCE Reports 82 In most studies, coronary segments with a diameter
KCE Reports 82 Multislice CT in Coronary Heart Disease 37 Figure 3: Clinical path of patients studied in trials and those deemed appropriate for MSCT by current guidelines Shaded area: patients studied in clinical trials so far. Dark grey area: patients in whom MSCT is CHEST PAIN ANGINA ATYPICAL CHEST PAIN NEGATIVE ECG STRESS TEST POSITIVE INCONCLUSIVE NEGATIVE MPS/DSE POSITIVE INCONCLUSIVE APPROPRIATE CANDIDATE FOR MSCT ? STANDARD CARE. CCA if APPROPRIATE. STANDARD CARE. CCA if APPROPRIATE. STANDARD CARE. CCA if APPROPRIATE. currently advocated in international guidelines. 108, 109 Bottom area: terra icognita. MPS: myocardial perfusion scintigraphy. DSE: dobutamine stress echocardiogram. CCA: conventional (invasive) coronary angiography. The most decisive evidence for judging the effectiveness of MSCT should come from randomised controlled trials. MSCT can affect patient outcome when the information obtained from it is used to guide decisions to start, withhold, modify or stop treatment. 113 Only patients in whom coronary imaging is deemed appropriate but the likelihood for revascularisation is low, should be enrolled in such a trial. If the potential need for revascularisation is high, invasive CCA is a more efficient first step because it allows to proceed to the therapeutic intervention (PCI) within the same procedure. Noninvasive imaging by MSCT can e.g. be envisaged for reassurance of a patient (or his/her cardiologist) or for making an early decision for discharge of a patient admitted with acute chest pain from the emergency department. Randomisation of such patients in a trial can take place at different decision points in the clinical path (after stress testing, MPS, or DSE) and against several alternative diagnostic options (MPS, DSE, CCA, sequential biomarkers). The outcome of such a trial should not focus on the correctness of the anatomical diagnosis but on endpoints that are relevant to patients, such as symptom control, prevention of MI, and prolongation of survival. From a societal perspective, long term downstream costs differences between different pathways should be obtained. Key point • There is an urgent need for evidence on (1) the diagnostic performance of MSCT in real world clinical practice, (2) its effect on patient outcomes (QoL, prevention of infarction, prolongation of life) and (3) its cost-effectiveness as compared to diagnostic pathways in which MSCT is not embedded.
Page 1 and 2: 64-Slice computed tomography imagin
Page 3: 64-Slice computed tomography imagin
Page 6 and 7: KCE reports 82 C Multislice CT in C
Page 13 and 14: KCE Reports 82 Multislice CT in Cor
Page 47: KCE Reports 82 Multislice CT in Cor
Page 99 and 100:
KCE Reports 82 Multislice CT in Cor
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
This page is left intentionally bla
Page 115:
KCE reports 33 Effects and costs of
show all

Download the full report (116 p.) - KCE

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?