Arq. Bras. Cardiol. 2022; 118(3): 586-587
It is Time for Coronary Computed Tomography Angiography to be Incorporated into the SUS
This Short Editorial is referred by the Research article "Cost-Effectiveness Analysis of CCTA in SUS, as Compared to Other Non-Invasive Imaging Modalities in Suspected Obstructive CAD".
In the evaluation of patients with stable coronary artery disease (CAD), also called chronic coronary syndrome (CCS), complementary tests are used both for diagnostic and prognostic purposes. , Anatomical (coronary angiography and coronary CT angiography) and functional (exercise testing, stress echocardiography, rest and stress myocardial perfusion imaging by scintigraphy, magnetic resonance, and positron emission tomography) tests are available. Coronary angiography, the gold standard, is invasive and therefore, indicated for clinically more severe patients, or those with poor prognostic findings in non-invasive testing, when myocardial revascularization is considered or planned.
The choice for the most appropriate diagnostic test is an important and challenging issue for the cardiologist in the clinical evaluation of CCS. The first step in this decision-making process is the assessment of the pre-test probability (PTP) of CAD. As recommended by the current SCC guidelines, , patients classified as having high PTP should receive medical therapy and undergo testing for prognostic information. The patients with low PTP should be assessed for an alternative diagnosis more likely than CAD. Patients with PTP calculated between 15-85% are in the intermediate range, where the complementary tests are more useful and important for CAD diagnosis. In addition to diagnostic accuracy and PTP, the selection of a non-invasive test depends on the clinical characteristics of patients, local expertise, and the availability of tests. In Brazil, it is estimated that up to 80% of the population depends exclusively on medical care provided by the public health system (SUS). In this context of managing economic resources, physicians and health managers should focus on the most cost-effective options for the diagnosis of CAD.
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