诊断性导管术适用标准要点.docxVIP

诊断性导管术适用标准要点 近日，美国心脏病学基金会（ACCF ）适用标准工作组联合心血管造影术 和介入治疗学会（SCAI X美国胸外科学会（AATS ）、美国心脏学会（AHA ）、 美国超声心动图学会（ASE ）、美国核心脏病学会（ASNC ）,美国心力 衰竭学会（HFSA ）、美国心律学会（HRS ）、危重症医学学会（SCCM ）、 心血管计算机断层显像学会（SCCT ）、心血管磁共振成像学会（SCMR） 以及胸外科医师学会（STS ）联合发布了 2012《诊断性导管术适用标准》。 临床适应证来自常规应用或预期的应用，以及当前的临床实践指南和 检验无创影像适用标准实施的研究结果。本标准中的166个适应证由多个 撰写组提出，并分别由独立的技术专家组评分，7~9分为适用，4~6分为 不确定，1 ~3分为不适用。 本适用标准能够影响医生的决策、医疗保健和支付政策。 Figure 2. Suspected CAD: Prior Noninvasive Stress Testing Indications 22 to 27 not covered in figure. CAD = coronaιy artery disease; ECG = electrocardiography. Figure 3. Suspected CAD: Prior Noninvasive Cardiac CT (Calcium Score and CTA) ,Coronary calcium score only rated for asymptomatic patients as these patients are the population in which it is used. CT = computed tomography; CTA = computed tomography angiography. Known Obstructive CADAsymptomatic∕∞ntrolledsymptoms or unchangedfindingsPost revascularizationUnprotected priorleft main PCI?NoUncertain Known Obstructive CAD Asymptomatic∕∞ntrolledsymptoms or unchangedfindings Post revascularization Unprotected priorleft main PCI? No Uncertain Figure 4. Patients With Known Obstructive CAD CAD coronary artery disease; PCI = percutaneous coronary intervention. Figure 5. Evaluation of Arrhythmias Figure 5. Evaluation of Arrhythmias Indication 63 for πewty diagnosed LBBB is not represented in this figure and was rated as , uncertain.* CHD ∞ronary heart disease; LBBB left bundle branch block; LV left ventricular; NI no∩invasive; VF - ventricular fibrillation; VT ventricular tachycardia. Figure 6. Preoperative Coronary Evaluation: Patients With No Prior Noninvasive Stress Testing METS = metabolic equivalents. Figure 7. Evaluation of Valvular Disease Preoperative assessment before valvular surgery is not represented in this figure and is rated appropriate. * Indication 90 for acute moderate or severe mitral or aortic regurgitation is not represented in this figure. Rating for ∞ncordant Imaging is ,uncertain and conflicting imping is appro