Статья
ОЦЕНКА ПРЕДТЕСТОВОЙ ВЕРОЯТНОСТИ В ДИАГНОСТИКЕ ОБСТРУКТИВНЫХ ПОРАЖЕНИЙ КОРОНАРНЫХ АРТЕРИЙ: НЕРЕШЕННЫЕ ВОПРОСЫ
Инвазивная коронароангиография является золотым стандартом диагностики ИБС, однако в значительном числе случаев при ее проведении не выявляются обструктивные поражения коронарных артерий. В настоящее время предложен диагностический алгоритм, основой которого является оценка претестовой вероятности (ПТВ) наличия ишемической болезни сердца. Следует отметить, что существующие международные руководства по-разному рекомендуют рассчитывать ПТВ, есть отличия и в дальнейшей тактике неинвазивного и инвазивного обследования. Кроме того, реальная клиническая практика свидетельствует о существенном завышении ПТВ при использовании рекомендованных в руководствах шкал. В обзоре рассматриваются различные шкалы оценки ПТВ, обсуждаются причины отличий получаемых результатов при их использовании, что способствует взвешенному применению в конкретных клинических ситуациях.
1. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012; 60: e44-e164.
2. Montalescot G, Sechtem U, Achenbach S, et al. Task Force Members. 2013 ESC guidelines on the management of stable coronary artery disease: The Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 2013; 34: 2949-3003.
3. Korok EV, Sumin AN, Sinkov MA, et al. The prevalence of intact coronary arteries in relation with indications for scheduled coronary arteriography. Russ J Cardiol 2016; 2: 52-9. (In Russ.) Корок Е. В., Сумин А. Н., Синьков М. А. и др. Частота выявления интактных коронарных артерий в зависимости от показаний для плановой коронарной ангиографии. Российский кардиологический журнал 2016; 2: 52-9. DOI: 10.15829/1560-4071-2016-2-52-59.
4. Tashakkor AY, Stone J, Mancini GB. Is it time to update how suspected angina is evaluated prior to the use of specialized tests implications based on a systematic review. Cardiology. 2016; 133 (3): 181-90.
5. Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010; 362 (10): 886-95.
6. Patel MR, Dai D, Hernandez AF, et al. Prevalence and predictors of nonobstructive coronary artery disease identified with coronary angiography in contemporary clinical practice. Am Heart J 2014; 167: 846–52.
7. Costa Filho FF, Chaves ÁJ, Ligabó LT, et al. Efficacy of patient selection for diagnostic coronary angiography in suspected coronary artery disease. Arq Bras Cardiol. 2015; 105 (5): 466-71.
8. Ferreira AM, Marques H, Tralhão A, et al. Pre-test probability of obstructive coronary stenosis in patients undergoing coronary CT angiography: Comparative performance of the modified diamond-Forrester algorithm versus methods incorporating cardiovascular risk factors. Int J Cardiol. 2016; 222: 346-51.
9. Genders TS, Steyerberg EW, Alkadhi H, et al. A clinical prediction rule for the diagnosis of coronary artery disease: Validation, updating, and extension. Eur Heart J 2011; 32: 1316-30.
10. Gaisenok OV, Martsevich SYu. Determination of Indications for Coronary Angiography in Asymptomatic Patients and Patients With Stable Angina. Kardiologija. 2014; 10: 57-62. (InRuss.) Гайсёнок О.В., Марцевич С.Ю. Определение показаний к проведению коронарографии у пациентов без клинических проявлений заболевания и больных со стабильной стенокардией. Кардиология. 2014; 10: 57-62.
11. SuminAN, KorokEV, BarbarashLS. Non-occlusive coronary artery lesions in the diagnosis of coronary artery disease: prevalence and verification tools. Ateroskleroz i dislipidemii. 2016; 1: 56-67. (In Russ.) Сумин А.Н., Корок Е.В., Барбараш Л.С. Необструктивные поражения коронарных артерий в диагностике ишемической болезни сердца: частота встречаемости и возможности верификации. Атеросклероз и дислипидемии. 2016; 1: 56-67.
12. SechtemU, MahrholdtH, OngP, etal. Testing in patients with stable coronary artery disease — the debate continues. Circ J. 2016; 80 (4): 802-10.
13. Smeeth L, Skinner JS, Ashcroft J, et al. Chest Pain Guideline Development Group. NICE clinical guideline: chest pain of recent onset. Br J Gen Pract. 2010; 60 (577): 607-10.
14. Diamond GA, Forrester JS. Analysis of probability in the clinical diagnosis of coronary artery disease. N Engl J Med 1979; 300: 1350-8.
15. Cheng VY, Berman DS, Rozanski A, et al. Performance of the traditional age, sex, and angina typicality-based approach for estimating pretest probability of angiographically significant coronary artery disease in patients undergoing coronary computed tomographic angiography: Results from the Multinational Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry (CONFIRM). Circulation 2011; 124: 2423-32
16. Pickett CA, Hulten EA, Goyal M, et al. Accuracy of traditional age, gender and symptom based pre-test estimation of angiographically significant coronary artery disease in patients referred for coronary computed tomographic angiography. Am J Cardiol 2013; 112: 208-11.
17. Bittencourt MS, Hulten E, Polonsky TS, et al. European Society of Cardiologyrecommended Coronary Artery Disease Consortium pretest probability scores more accurately predict obstructive coronary disease and cardiovascular events than the Diamond and Forrester score: The Partners Registry. Circulation. 2016; 134 (3): 201-11.
18. Abidov A, Rozanski A, Hachamovitch R, et al. Prognostic significance of dyspnea in patients referred for cardiac stress testing. N Engl J Med. 2005; 353 (18): 1889-98.
19. Pryor DB, Shaw L, McCants CB, et al. Value of the history and physical in identifying patients at increased risk for coronary artery disease. Ann Intern Med 1993; 118: 81-90.
20. Genders TS, Steyerberg EW, Hunink MG, et al. Prediction model to estimate presence of coronary artery disease: retrospective pooled analysis of existing cohorts. BMJ. 2012; 344: e3485.
21. Demarco DC, Papachristidis A, Roper D, et al. Pre-test probability risk scores and their use in contemporary management of patients with chest pain: One year stress echo cohort study. JRSM Open. 2015; 6 (11): 2054270415611295.
22. Demir OM, Dobson P, Papamichael ND, et al. Comparison of ESC and NICE guidelines for patients with suspected coronary artery disease: evaluation of the pre-test probability risk scores in clinical practice. Clin Med (Lond). 2015; 15 (3): 234-8.
23. Min JK, Dunning A, Gransar H, et al., Medical history for prognostic risk assessment and diagnosis of stable patients with suspected coronary artery disease. Am. J. Med. 2015; 128 (8): 871-8.
24. Gueret P, Deux JF, Bonello L, et al. Diagnostic performance of computed tomography coronary angiography (from the Prospective National Multicenter Multivendor EVASCAN Study). Am J Cardiol 2013; 111: 471-8.
25. Miller JM, Rochitte CE, Dewey M, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008; 359: 2324-36.
26. Meijboom WB, Meijs MF, Schuijf JD, et al. Diagnostic accuracy of 64-slice computed tomography coronary angiography: A prospective, multicenter, multivendor study. J Am Coll Cardiol 2008; 52: 2135-44.
27. Mouden M, Timmer JR, Reiffers S, et al. Coronary artery calcium scoring to exclude flowlimiting coronary artery disease in symptomatic stable patients at low or intermediate risk. Radiology 2013; 269: 77-83.
28. Rio P, Ramos R, Pereira-da-Silva T, et al. Yield of contemporary clinical strategies to detect patients with obstructive coronary artery disease. Heart Int. 2016; 10 (1): e12-9.
29. Yuan JW, Wang YT, Lu CZ. Coronary arteriography in the diagnosis results and prognosis analysis of suspected coronary artery disease in patients with normal SPET myocardial perfusion imaging. Hell J Nucl Med. 2015; 18 (3): 215-21.