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Chest pain

Causes
Clinical features
Investigations
Therapy
Prognosis
Investigations

For patients with possible coronary artery disease, but no clear evidence, consider 
  • single-photon emission computed tomography) a  

Why?

An abnormal exercise SPECT makes coronary artery disease more likely

Patient Target Disorder and
Reference Standard		 Diagnostic Test LR+
(95% CI)		 Post-test Probability LR-
(95% CI)		 Post-test Probability
suspected coronary artery disease a
(pre-test probability: 76%)		 coronary artery disease
(coronary angiography)		 exercise SPECT 2.2
(2.0 to 2.4)		 87% 0.18
(0.16 to 0.20)		 36%
 

Note:

  • There is little difference in the cost-effectiveness of angiography, PET (positron emission tomography), SPECT, echocardiography or thallium scanning. a

 

Expiry date: June 2003
Levels of Evidence used in grading these guides

Author   CM   Ball
Reviewer   S   Straus
CAT Writers   CJ   Wotton , CM   Ball , N   Shenker , RS   Phillips