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Noninvasive Technologies for Diagnosing Coronary Artery Disease in Women

Slide: 21 of 23

Gaps in Knowledge and Future Research Needs (2 of 2)

In general, because there are few patients with high pretest probability, most clinicians would prefer to have patients undergo diagnosis with one noninvasive technology (NIT) before choosing a treatment choice or referral for coronary angiography. More than one NIT test is often required when the initial test results are equivocal. The comparative effectiveness review did not identify studies that discussed the order in which different NITs were used to evaluate coronary artery disease (CAD). In fact, multiple testing or layered-testing strategies are areas where significant research is needed.

Using diagnostic procedures to screen for CAD can result in harmful clinical events (e.g., nephropathy, radiation exposure, access site complications). Systematic reporting of adverse events in publications — in total and by sex — is essential to determine which NITs are safe for use in clinical practice.

The accuracy of the NITs may be location or operator dependent; thus, the results of published studies conducted at highly specialized centers may not uniformly apply to routine practice.