The noninvasive evaluation of the coronary artery disease patient: clinical, economic and social issues.

The patient with chest pain is a common but often challenging diagnostic problem to the physician. Evaluating such a patient for coronary artery disease requires a careful history, physical examination and judicious selection of laboratory procedures. Noninvasive stress tests for cardiac diagnosis need not be applied to every patient who presents with chest pain and, in general, are most likely to be helpful when they are used discriminately for patients who have an intermediate likelihood of coronary artery disease. A further elaboration of one systematic approach to this problem, based on Bayesian analysis of noninvasive testing procedures, is presented.