Current approach to the diagnosis of atherosclerotic coronary artery disease: more questions than answers. (October 2019)

• Record Type: Journal Article
• Authors: Nelson, Adam J.; Ardissino, Maddalena; Psaltis, Peter J.
• Is Part Of: Therapeutic advances in chronic disease. Volume 10(2019)
• Publication Date: 2019-10
• Subjects: coronary CT angiography -- coronary angiography -- coronary artery disease -- myocardial ischaemia -- stress testing; Chronic diseases -- Periodicals; Chronic diseases -- Treatment -- Periodicals; Chronic Disease -- Periodicals; Chronic Disease -- therapy -- Periodicals; 616.044
• DOI: 10.1177/2040622319884819
• Languages: English
• ISSNs: 2040-6223

Abstract

Despite its commonality in routine clinical practice, the approach to a diagnosis of atherosclerotic coronary artery disease remains complex and, in part, contentious. The traditional dogma linking ischaemia to hard clinical outcomes has been questioned and reframed over the years; rather than being a predictor of hard clinical outcomes, the degree of ischaemia may simply be a marker of atherosclerotic disease burden. A renewed interest in the imaging of plaque burden has spawned the contemporary role of CT imaging for not only diagnosis and prognosis, but also for dictating downstream management. As the technology develops and evidence expands, decisions on investigative modalities remain centred around patient factors, local availability, test performance and cost. This review summarizes the available methods for diagnosis in the symptomatic patient and provides an overview of the current evidence behind functional and anatomical approaches.