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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.)

  • This publication is provided for historical reference only and the information may be out of date.

This publication is provided for historical reference only and the information may be out of date.

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Screening for Asymptomatic Coronary Artery Disease [Internet].

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2Methods

To identify the relevant literature, we searched MEDLINE from 1966 through June 2002. We used the following MeSH headings and keywords: (Coronary disease and asymptomatic) or (Myocardial Infarction and silent) and (electrocardiography or exercise test or tomography, x-ray computed or echocardiography) and (diagnosis or prognosis), limited to English language and human subjects. In addition to these general searches, we also searched MEDLINE for articles on several specific electrocardiographic findings, including left ventricular hypertrophy, ventricular arrythmias, and ST segment changes or T wave inversions. We also performed hand searches of the bibliographies of key articles and used other recent systematic reviews when available to supplement our literature searches.

Two reviewers examined the abstracts of the articles identified in the initial MEDLINE search and resolved disagreements about inclusion by consensus. Two reviewers examined the full text of the remaining articles to determine final eligibility. To be eligible, studies had to be performed in patients with no previous history of cardiovascular disease and to report the independent effect of the test on the incidence of CHD events, the proportion of patients receiving CHD risk-reducing treatments, or the risk of future CHD events. When reporting the prognostic benefit of ECG, ETT, and EBCT, studies have used different means of characterizing results. Many studies have reported the outcomes in terms of independent relative risk associated with a positive (versus a negative) screening test. Others have used diagnostic test terminology, such as sensitivity and specificity or positive predictive value. In such cases, the terms are used to indicate test accuracy over the entire follow-up period, rather than at one point in time (e.g. sensitivity is the proportion of all patients who go on to have a CHD event that had positive screening tests at baseline; positive predictive value is the proportion of all patients screening positive that go on to have a CHD event).

We rated the quality of the included articles according to criteria developed by the USPSTF Methods Work Group.7 We used the final set of eligible articles to create evidence tables and a draft report, which was submitted for external peer review and subsequently revised as appropriate (see Appendix for the list of peer reviewers).

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