Prevention and Early Diagnosis, Acute-Care and Follow-Up of Coronary Artery Disease
CAD is a regional manifestation of arteriosclerosis, which is a chronic and systemic disease of the entire arterial system. CAD like other arteriosclerotic manifestations (stroke, peripheral artery disease) usually in the third decade of life as autopsy studies have demonstrated decades ago.
Prevention and Early Diagnosis
Multiple risk factors for CAD are known and well studied. Risk assessments like the Framingham Risk Score or HeartSCORE allow statistical CAD risk estimation. Lab tests are used for evaluation of known risk factors like hyperlipedemia, diabetes mellitus, homocystein, LpA or hs-CRP.
In order to reduce CAD mortality, detection of early disease is mandatory. Diagnostic tests such as stress ECG, stress echocardiography or SPECT Myocardial Perfusion Imaging (MPI) demonstrate abnormal results only after the disease has already developed a clinically significant coronary stenosis. A detectable reduction in cardiac perfusion is required to identify clinical disease.
Acute-Care
Patients with acute clinical symptoms require a fast and accurate diagnostic approach as the underlying diseases may be life threatening. As the patient's clinical condition is often poor the patient requirements dictated by the procedure need to be considered. For example, exams should not require long breath-holds.
Patient history, physical exam, ECG, lab tests and standard echo are routine at the time of initial presentation. When inconclusive additional diagnostic tests are of great importance.
Follow-Up
CAD is a chronic disease with patients experiencing different clinical courses. Follow-up and patient management are mandatory.
In long term follow-up, reproducibility of test results is crucial in detecting disease progression in clinically stable patient. Early detection enables adapting therapy to avoid deterioration of clinical condition, patient morbidity and hospitalization. As patients will undergo repeated exams, minimizing side effects is required. Radiation dose and procedure invasiveness need to be taken into account.
Important clinical information is accumulated during the patient history and needs to be handled smoothly and effectively. IT is playing a great and increasingly important role in efficient patient management. Cardiovascular Information and Picture Archiving and Management systems enable access to and trending of all relevant information, from lab tests and ECG to imaging studies, when and where you need them.
