Considerations in the evaluation of the stable CAD patient have changed with an improved understanding of CAD.
Recent clinical trials offer insights related to test choice and patient choice. Normal coronary flow reserve excludes severe CAD.
Changed paradigms in CAD evaluation
Old – Is there obstructive CAD? New – Is there obstructive or nonobstructive CAD? Are symptoms due to CAD? Is there microvascular disease?
Old – Is the patients at a higher risk for MACE? New – Will revascularization impact prognosis or will medical treatment suffice?
Many patients will require a combination of anatomy and functional evaluation.
In the PROMISE trial, a comparison of coronary computed tomographic angiography (CTA) and functional testing found no difference in outcome (death, MI, hospitalization for unstable angina or major procedural complication) (Douglas PS, et al. N Engl J Med. 2015;372:1291-300).
Practical approaches should be followed.
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