Utility of stress testing and coronary calcification measurement for detection of coronary artery disease in women

Khurram Nasir, Rita F. Redberg, Matthew J. Budoff, Elaine Hui, Wendy S. Post, Roger S. Blumenthal

Research output: Contribution to journalReview article

22 Scopus citations

Abstract

Accurate and safe diagnostic testing provides the crucial link between detection and optimal management of coronary artery disease (CAD). Noninvasive diagnostic testing for CAD may be less accurate in women than in men. Many noninvasive diagnostic modalities are available for this purpose. An exercise tolerance test provides an assessment of functional capacity and has the advantages of wide availability and low initial cost. However, exercise echocardiography may be the most cost-effective method for the initial assessment of coronary artery disease in intermediate-risk women owing to its higher sensitivity and specificity. Recent studies with electron-beam computed tomography reveal that women with no coronary calcification are very unlikely to have obstructive CAD. In symptomatic women with an intermediate likelihood of CAD, either an exercise treadmill test or exercise echocardiography is appropriate for initial screening and can provide useful prognostic information. Alternatively, an electron-beam computed tomographic scan with a 0 calcium score may spare many women with atypical chest pain or equivocal findings on an exercise tolerance test from undergoing more expensive stress imaging studies or coronary angiography. For high-risk symptomatic women, a more aggressive approach involving coronary angiography appears to be the preferred initial diagnostic strategy.

Original languageEnglish (US)
Pages (from-to)1610-1620
Number of pages11
JournalArchives of Internal Medicine
Volume164
Issue number15
DOIs
StatePublished - Aug 9 2004

ASJC Scopus subject areas

  • Internal Medicine

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