Efficacy of Diagnostic Testing of Suspected Coronary Artery Disease: A Contemporary Review.

Abstract

Coronary artery disease (CAD) affects over 20 million Americans and its' spectrum of impact leads to an estimated 7 million deaths, as well as the loss of 129 million disability-adjusted life years, worldwide, each year. CAD develops as atherosclerotic plaque forms in the coronary arteries. These plaques can eventually limit blood flow to myocardial tissue resulting in ischemia a risk for acute plaque rupture and acute coronary syndrome. While chest pain may represent a wide array of underlying diseases, given the high morbidity and mortality associated with CAD, an ischemic cardiac etiology must always be considered. Early diagnosis and treatment of CAD can improve patient outcomes through guiding risk factor modification and treatment modalities including medical and invasive approaches. While discovering coronary disease early can allow for treatments which can yield great benefit13, many tests are equivocal and can be associated with additional risk and unnecessary cost. This leaves the question; if there is some concern for stable CAD, who should we test, and which modality should be used? This comprehensive review aims to describe the available CAD testing modalities, detail their risks and benefits, and describe when each should be considered in the evaluation of a patient with suspected CAD. (Central illustration).