Espert

by No Name Given

Original Text:


Espert


Although the attitude of the clinician is to “make a diagnosis”, we are increasingly considering the prognosis in our primary objective decision-making algorithms. To identify classes of patients with different probabilities of events at a distance, and even in the presence of angiographic data, it is necessary to acquire ventricular function data, functional assessment of stenosis and identification – in patients with recent or previous myocardial infarction – the share of residual viable myocardium. Similarly, in patients with suspected coronary heart disease, any indications at the coronary examination should be given only in the group of patients to which myocardial revascularisation treatment can improve the prognosis in a statistically significant way compared to medical therapy (MT). The scenario is then even more complex if we consider some pathophysiological aspects and especially the non-linear relationship between the degree of stenosis and the risk of events. Diagnostic tests derive a long list of variables which, singly or in combination, can be used to identify groups of patients with different prognoses, including mortality and myocardial infarction. The more correct the characterisation of the prognosis obtained from diagnostic tests, the more it will be possible to identify the treatment for the most favourable prognosis. This becomes of significant clinical value, if the outcome is as homogenous and standardised as possible, even given the frequent finding of tests whose results are difficult to interpret with the effect being to limit their clinical impact.

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Revised Text:

Although the attitude of the clinician is to “make a diagnosis”, we are increasingly considering the prognosis in our primary objective decision-making algorithms.

To identify classes of patients with different probabilities of events at a distance, and even in the presence of angiographic data, it is necessary to acquire ventricular function data, functional assessment of stenosis and identification (in patients with recent or previous myocardial infarction) of the share of residual viable myocardium. Similarly, in patients with suspected coronary heart disease, any indications at the coronary examination should be given only in the group of patients in which myocardial re-vascularisation treatment can improve the prognosis in a statistically significant way when compared to medical therapy (MT).

The scenario is then even more complex if we consider some patho-physiological aspects and especially the non-linear relationship between the degree of stenosis and the risk of events. Diagnostic tests derive a long list of variables which, singly or in combination, can be used to identify groups of patients with different prognoses, including mortality and myocardial infarction. The more correct the characterisation of the prognosis obtained from diagnostic tests, the more it will be possible to identify the treatment for the most favourable prognosis. This becomes of significant clinical value if the outcome is as homogenous and standardised as possible, even given the frequent finding of tests whose results are difficult to interpret with the effect being to limit their clinical impact.

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