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CSI 2021: Evaluation of Stable CAD in 2021

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eMediNexus    07 January 2022

  • 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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