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Contemporary Management of Stable Coronary Artery Disease

Dario Tino Bertolone1,2, Emanuele Gallinoro1,3, Giuseppe Esposito1,2

  • 1Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.

High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension
|February 11, 2022
PubMed

Insights

Assessing pre-test probability (PTP) improves coronary artery disease (CAD) diagnosis, guiding appropriate non-invasive testing like coronary computed tomography angiography (CCTA). This approach optimizes management for chronic coronary syndromes (CCS) and reduces unnecessary invasive procedures.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Preventive Medicine

Background:

  • Coronary artery disease (CAD) is a primary cause of death globally.
  • Accurate pre-test probability (PTP) assessment aids in selecting appropriate diagnostic tests for suspected CAD.
  • Non-invasive imaging, particularly coronary computed tomography angiography (CCTA), is crucial for initial evaluation.

Purpose of the Study:

  • To present an updated diagnostic and therapeutic strategy for stable coronary artery disease (CAD).
  • To emphasize the role of PTP and non-invasive imaging in guiding CAD management.
  • To discuss current approaches for chronic coronary syndromes (CCS) and secondary prevention.

Main Methods:

  • Review of current literature on CAD diagnosis and management.
  • Emphasis on pre-test probability (PTP) assessment using patient characteristics, gender, and symptoms.
  • Discussion of non-invasive imaging (CCTA) and invasive coronary angiography (ICA) roles.
  • Inclusion of physiology and imaging-guided revascularization strategies.
  • Overview of contemporary medical therapies for secondary prevention.

Main Results:

  • PTP assessment refines the selection of diagnostic tests, improving accuracy.
  • Coronary computed tomography angiography (CCTA) serves as a first-line non-invasive tool for suspected CAD.
  • Invasive coronary angiography (ICA) is reserved for inconclusive non-invasive tests or high clinical likelihood.
  • A significant percentage of patients undergoing ICA have non-obstructive coronary artery disease (INOCA).
  • Physiology and imaging-guided revascularization are key for managing chronic coronary syndromes (CCS).

Conclusions:

  • An integrated approach using PTP, non-invasive imaging (CCTA), and physiology-guided revascularization enhances CAD management.
  • This strategy aims to improve patient outcomes and reduce unnecessary invasive procedures.
  • Optimal medical therapy is essential for secondary prevention in CAD patients.

Keywords:
AnginaChronic coronary syndromeCoronary artery diseaseCoronary computed tomography angiographyFractional flow reservePercutaneous coronary intervention

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