ABC | Volume 114, Nº2, February 2020

Update Update of the Brazilian Guideline on Nuclear Cardiology – 2020 Arq Bras Cardiol. 2020; 114(2):325-429 Figure 33 – Case 6 - Electrocardiogram tracing showing electrocardiographic alterations (ST depression), especially during the recovery phase of the exercise c test. important physiological impact. Like Case 1 , the situation presented in Case 6 is common in routine coronary angio-CT. In cases where ET shows intermediate or low risk and, especially, in those where the patient has intermediate or low pre-test probability, angio-CT has one of its most precise indications. The main diagnostic virtue of angio-CT is its high NPV which essentially excludes CAD. Thus, if the probability of disease is intermediate or low, the chance of excluding it is greater, and the test shows better benefits. In the case described, as symptoms persisted, complementary evaluation with angio-CT was highly useful to the medical decision-making process. Furthermore, prognosis in a patient without CAD on angio-CT is excellent, with nearly zero risk of AMI and coronary events for up to 5 years, 249 owing to its high NPV and to the fact that characteristic evolution of CAD habitually progresses slowly, with individual variations, and this lowers the chances of an individual developing CAD culminating in a coronary event over a period of 5 years. Integrated analysis of these exams, in the case therefore, infers an excellent prognosis, notwithstanding the altered ET, and its rules out CAD quite safely, in the 375