Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology
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In patients suspected of having coronary artery disease (CAD), noninvasive testing has been playing an increasing role in selecting patients who would require coronary angiography for either the "definitive" diagnosis of CAD or as a prelude to planning myocardial revascularization. A mathematic model is presented that defines cost-effective utility of nuclear cardiology testing for diagnosis of CAD and selection of appropriate candidates for coronary angiography, according to quantitative methods of decision analysis. Clinical utility or effectiveness was defined in terms of percent correct diagnosis of CAD. ⋯ The latter patients would then be candidates for coronary angiography. In all patients with an abnormal rest electrocardiogram, the most cost-effective strategy is uniform referral to nuclear cardiac testing (which is performed in conjunction with exercise electrocardiography), regardless of the pretest likelihood of CAD; a negative or a positive nuclear test result would indicate low or high risk for coronary events, respectively. The latter group would be proper candidates for referral to coronary angiography.