La diagnosi di cardiopatia ischemica nella donna

Risk stratification and therefore evaluation of pre-test probability of coronary artery disease represent an important point in order to choose the ideal noninvasive test in women. Risk evaluation may be performed in relation to the presence of so-called major (hypertension, diabetes, age > 65 years) or minor (dyslipidemia, smoking abuse) risk factors. The standard ECG exercise test represents an important step, but only if easily interpretable and feasible: a complete negative test suggest the absence of coronary artery disease; its positivity should indicate the opportunity to perform coronary angiography in the presence of moderate to severe pre-test probability. If ECG exercise test is not feasible, we would suggest a test of imaging; in the case of high pre-test probability we would recommend a test with high specificity, such as echo-stress test, whereas in the case of lower pre-test probability we would prefer a test with high sensitivity, such as myocardial scintigraphy.