Non-invasive Risk Stratification for Coronary Artery Disease: Is It Time for Subclassifications?

Journal Article · Thu Aug 15 04:00:00 EDT 2019 · Current Cardiology Reports (Print)

DOI:https://doi.org/10.1007/S11886-019-1174-0· OSTI ID:22929218

Iyngkaran, Pupalan ^[1]; Noaman, Samer ^[2]; Chan, William ^[3]; Mahadavan, Gnanadevan ^[4]; Thomas, Merlin C. ^[5]; Rajendran, Sharmalar ^[4]

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1. Flinders University, Consultant Cardiologist Heart West Melbourne Victoria and NT Medical School (Australia)
2. University of Melbourne (Australia)
3. University of Melbourne, Consultant & Interventional Cardiologist Alfred/Western/ Epworth (Australia)
4. University of Adelaide, Northern and Central Adelaide Local Network (Australia)
5. Biochemistry of Diabetes Complications (Australia)

Purpose of Review: Coronary artery disease (CAD) is the leading contributor to cardiovascular disease; it is the most prevalent non-communicable disease globally and has high morbidity, mortality and health care cost. Risk stratification is defined as prevention or containment of disease prior to it occurring or progressing, and non-invasive surrogates include history, examination, biomarkers and non-invasive imaging. This review aims to highlight advancement in current diagnostic strategies and explores gaps for CAD secondary to atherosclerosis and non-obstructive vascular diseases. Recent Findings: Cardiac risk scores have largely proven inadequate in risk stratifying heterogeneous patient populations. Greater emphasis should also be provided to posttest risk stratification. Non-invasive imaging with MRI is the most accurate but least cost efficacious presently due to availability and expertise. Echocardiography and nuclear imaging have good accuracy, but radiation limits the latter. Novel echocardiographic technologies may increase its appeal. Cardiac CT angiography is increasingly promising. Summary: Non-invasive and minimally invasive imaging has significantly influenced the cost-efficacy trajectory of coronary artery disease diagnosis and management. Recent studies suggest that future guidelines will incorporate more subclassifications from the findings of these novel technologies and for more diverse patient demographics.

• OSTI ID: 22929218
• Journal Information: Current Cardiology Reports (Print), Journal Name: Current Cardiology Reports (Print) Journal Issue: 8 Vol. 21; ISSN 1523-3782
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ARTERIOSCLEROSIS
BIOLOGICAL MARKERS
BIOMEDICAL RADIOGRAPHY
COMPUTERIZED TOMOGRAPHY
CORONARIES
DIAGNOSIS
DISEASE INCIDENCE
NMR IMAGING
PATIENTS