Chronic Coronary Syndrome and Acute Coronary Syndrome

• For patients with suspected chronic coronary syndrome and intermediate pre-test probability of obstructive CAD, coronary CT angiography (CTA) may be preferred as the initial test if such patients are at the lower end of the range of clinical likelihood of CAD.
• If at the higher end of the range, then functional stress testing may be preferable. However, other factors such as certain patient characteristics, local expertise and patient’s preference may also dictate the choice.
• For patients presenting with suspected acute coronary syndrome (ACS), coronary CTA is recommended to exclude ACS in patients with low to intermediate likelihood of CAD when cardiac troponins and ECG are normal/inconclusive but the clinical suspicion of ACS is high.
• Coronary CTA is not recommended in patients with pre-existing CAD, extensive coronary calcification, coronary stents, previous CABG and when there is severe obesity, irregular heart rate and inability to cooperate with breath-hold commands.