안정형 허혈성 심질환 환자에서 CAG 적응증

안정형 허혈성 심질환 환자에서 noninvasive testing
: https://blog.naver.com/sjloveu2/221346517064

안정형 허혈성 심질환 환자에서 CAG 적응증은 다음과 같습니다.

해리슨 20판에서 언급된 적응증은 다음과 같습니다. 약물 치료에도 불구하고 심한 증상을 나타내는 것은 아니지만 pilots, firefighters, police와 같이 다른 사람의 안전과 관련된 직업을 갖은 환자는 coronary arteriography의 적응증에 해당된다는 내용이 있습니다.
(1) Patients with chronic stable angina pectoris who are severely symptomatic despite medical therapy and are being considered for revascularization, i.e., a percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)

(2) Patients with troublesome symptoms that present diagnostic difficulties in whom there is a need to confirm or rule out the diagnosis of IHD

(3) Patients with known or possible angina pectoris who have survived cardiac arrest

(4) Patients with angina or evidence of ischemia on noninvasive testing with clinical or laboratory evidence of ventricular dysfunction

(5) Patients judged to be at high risk of sustaining coronary events based on signs of severe ischemia on noninvasive testing, regardless of the presence or severity of symptoms.

(6) Examples of other indications for coronary arteriography include the following:
   ㉠ Patients with chest discomfort suggestive of angina pectoris but a negative or nondiagnostic stress test who require a definitive diagnosis for guiding medical management, alleviating psychological stress, career or family planning, or insurance purposes.
   ㉡ Patients who have been admitted repeatedly to the hospital for a suspected acute coronary syndrome, but in whom this diagnosis has not been established and in whom the presence or absence of CAD should be determined.
   ㉢ Patients with careers that involve the safety of others (e.g., pilots, firefighters, police) who have questionable symptoms or suspicious or positive noninvasive tests and in whom there are reasonable doubts about the state of the coronary arteries.
   ㉣ Patients with aortic stenosis or hypertrophic cardiomyopathy and angina in whom the chest pain could be due to IHD.
   ㉤ Male patients >45 years and females >55 years who are to undergo a cardiac operation such as valve replacement or repair and who may or may not have clinical evidence of myocardial ischemia.
Patients after myocardial infarction, especially those who are at high risk after myocardial infarction because of the recurrence of angina or the presence of heart failure, frequent ventricular premature contractions, or signs of ischemia on the stress test.
  ㉥ Patients with angina pectoris, regardless of severity, in whom noninvasive testing indicates a high risk of coronary events (poor exercise performance or severe ischemia).
  ㉦ Patients in whom coronary spasm or another nonatherosclerotic cause of myocardial ischemia (e.g., coronary artery anomaly, Kawasaki disease) is suspected.

참고문헌 : 1. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: Executive Summary  2. 해리슨 20판