Screening for Asymptomatic Coronary Artery Disease
Pignone M, Fowler-Brown A, Pletcher M, et al. Screening for Asymptomatic Coronary Artery Disease [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2003 Dec. (Systematic Evidence Reviews, No. 22.)
We reviewed the evidence on the value of screening asymptomatic patients with resting electrocardiogram (ECG), exercise electrocardiogram treadmill test (ETT), or electron beam computerized tomography (EBCT).
We searched MEDLINE 1966 – June 2002 to identify studies examining the independent value of ECG, ETT, and EBCT in patients with no known history of cardiovascular events. We sought to identify studies that examined the use of these tests compared with traditional risk assessment of coronary heart disease (CHD) as a means of reducing CHD events, improving the use of CHD risk-reducing treatments, or producing more accurate assessments of actual CHD risk.
No studies examined the effect of screening asymptomatic patients with ECG, ETT, or EBCT on CHD outcomes. Two fair quality studies examined the effect of a positive EBCT on self-reported adoption of risk-reducing behaviors and found mixed results. ECG, ETT, and EBCT each can provide independent prognostic information about the risk of CHD events, mainly in middle-aged or older adults, but the effect of this information on clinical decisionmaking is unclear. When the risk of CHD events is low, however, most positive findings will be false positives and may result in unnecessary further testing.
Although ECG, ETT, and EBCT can provide prognostic information about the risk of future CHD events, the effect of this information on clinical management or disease outcomes in asymptomatic patients is unclear.