Abstract
Coronary artery disease continues to be the leading cause of death in developed countries. As coronary atherosclerosis worsens, luminal narrowing caused by coronary plaque mass may result in haemodynamic obstruction and subsequently, angina pectoris symptoms may occur. To avoid redundant invasive procedures and minimize its complications, noninvasive imaging is often performed for an initial assessment of patients with suspected coronary artery disease, serving as a gatekeeper for invasive coronary angiography. The diagnostic accuracy and prognostic value of these strategies have been confirmed in many single-center or multi-center trials. In 2013 the updated ESC guidelines on the management on stable coronary artery disease were released, highlighting the aspect that the diagnostic algorithm is based on the pre-test-probability of coronary artery disease. The consideration of new imaging modalities such as cardiovascular magnetic resonance imaging and coronary CT angiography however, makes it harder for the referring physician to choose the right imaging modality for a patient. This article reviews the clinical utility and the limitations of the most widely used noninvasive imaging modalities and summarizes the diagnostic work-up according to the current ESC guidelines.
