The diagnostic process of stable angina: still many doubts since Heberden's first description 250 years ago

Area of Science:

• Cardiology
• Diagnostic Imaging
• Clinical Medicine

Background:

• Stable angina diagnosis presents ongoing clinical challenges.
• Current guidelines inadequately identify patients needing coronary angiography, leading to unnecessary procedures.
• Over-reliance on coronary angiography as a primary diagnostic tool results in revascularizations with questionable benefit.

Purpose of the Study:

• To review current evidence on noninvasive diagnostic strategies for stable angina.
• To discuss the ongoing debate between anatomic (computed tomography) and functional (myocardial ischemia) testing.
• To explore the potential benefits of a combined anatomic and functional testing approach for risk stratification.

Main Methods:

• Review of recent clinical trials comparing computed tomography angiography and myocardial ischemia assessment.
• Analysis of evidence supporting combined functional and anatomic noninvasive testing.
• Discussion of clinical practice applications for improved diagnostic pathways.

Main Results:

• Recent trials have not definitively resolved the anatomic vs. functional testing debate.
• A combined approach may offer superior risk stratification compared to single-modality testing.
• Noninvasive testing is crucial before resorting to invasive coronary angiography.

Conclusions:

• Optimizing stable angina diagnosis requires careful consideration of noninvasive testing modalities.
• A combined anatomic and functional assessment strategy holds promise for more accurate patient selection for invasive procedures.
• Further research and clinical integration of combined testing are warranted to refine stable angina management.