Diagnostic evaluation of the patient with coronary artery disease.

BACKGROUND Evaluation of patients with possible coronary artery disease is a challenge to clinicians who face conflicting pressures in the current practice environment. Sensitivity, accuracy, cost, and access have become considerations in the appropriate selection of diagnostic studies. OBJECTIVE To review and compare the strengths and shortcomings of commonly employed noninvasive techniques for diagnosing coronary artery disease. DISCUSSION The patient's history is still key in establishing a diagnosis. Exercise electrocardiography (ECG) is not as sensitive or specific as exercise echocardiography or radionuclide studies, but it is relatively inexpensive and accessible. Further, new criteria for interpreting the results of exercise ECG may improve its diagnostic accuracy. The predictive value of any test increases in populations where the prevalence of disease is higher, as in patients with known risk factors for coronary artery disease. Patients who cannot exercise or who have concomitant conditions that obscure the results of exercise ECG are candidates for other diagnostic techniques. CONCLUSION Rational diagnostic plans for evaluating patients who may have coronary disease can be developed on the basis of existing information and reported experience.