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**8**

**11**

**Chapter 2**

**Abstract**

advancement.

appropriate use criteria

**1. Introduction**

Application of Bayesian Principles

Artery Disease in the Modern Era

The number of testing modalities available for the diagnosis of significant coronary artery disease has grown over the last few decades. Inappropriate utilization of these tests often leads to: (i) further investigation, (ii) physician and patient uncertainty, (iii) harm and poor outcomes, and (iv) increase in health care costs. An informed approach to the evaluation of the patients with stable ischemic chest pain can lead to efficient use of resources and better outcomes. Throughout the course of this chapter, we will explain how the applications of age-old statistical principles are still relevant in this modern era of technological

**Keywords:** Bayes' theorem, coronary artery disease, ischemic heart disease,

intervention (PCI) for ST-segment elevation MI [4, 5].

coronary artery disease as a cause of their chest pain [6].

with suspected stable ischemic heart disease [9, 10].

Cardiovascular diseases (CVDs) remain a leading cause of death across the world [1]. Ischemic heart disease (IHD) is one of the largest contributors to these deaths both globally and in the United States of America [2] and contributes to years of productivity loss due to complications from disease sequelae. These include non-fatal myocardial infarction, stable angina pectoris and symptomatic ischemic cardiomyopathy. Although the number of deaths resulting from fatal MI has been decreasing, the number of quality years lost from IHD complications has been increasing [3]. The decrease in mortality is largely due to interventions for the management of acute coronary syndromes (ACS) and early percutaneous coronary

There are a variety of scoring systems/tools which have been used to predict (with varying degrees of success), which patients are likely to have obstructive

The most frequently used clinical decision making tool to decide the likelihood of CAD on the basis of patient characteristics, is the Diamond-Forrester classification [7]. It is derived from the application of Bayesian principles [8] and has formed the backbone of many of the guideline statements for the management of patients

Due to the limitations of the history and physical examination in determining the likelihood of disease, clinicians have utilized various testing modalities

to the Evaluation of Coronary

*John-Ross D. Clarke and Gilead I. Lancaster*
