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

  • Cardiac PET, CT, and MRI (P Schoenhagen, Section Editor)
  • Published:
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Abstract

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.

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Notes

  1. Non-invasive strategies in this review incorporate risk scores, functional and anatomical information on CAD; imaging utilizing injected contrast, radioactive isotopes or drugs labelled ‘minimally invasive’ are also included.

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Authors and Affiliations

  1. Consultant Cardiologist Heart West Melbourne Victoria and Senior Lecturer, NT Medical School, Flinders University, Darwin, Australia

    Pupalan Iyngkaran

  2. University of Melbourne, Melbourne, Australia

    Samer Noaman

  3. University of Melbourne; Consultant & Interventional Cardiologist Alfred/Western/ Epworth, Melbourne, Victoria, Australia

    William Chan

  4. Northern and Central Adelaide Local Network, University of Adelaide, Adelaide, Australia

    Gnanadevan Mahadavan

  5. Biochemistry of Diabetes Complications, Melbourne, Australia

    Merlin C. Thomas

  6. Northern and Central Adelaide Local Network, University of Adelaide, Adelaide, Australia

    Sharmalar Rajendran

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  1. Pupalan Iyngkaran
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Correspondence to Pupalan Iyngkaran.

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P. Iyngkaran, S. Noaman, W. Chan, G. Mahadavan, M.C. Thomas and S. Rajendran have won independent and governmental research funding. None pose a conflict of interest for this review.

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Iyngkaran, P., Noaman, S., Chan, W. et al. Non-invasive Risk Stratification for Coronary Artery Disease: Is It Time for Subclassifications?. Curr Cardiol Rep 21, 87 (2019). https://doi.org/10.1007/s11886-019-1174-0

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