Comparative assessment of non-invasive imaging in detecting coronary artery disease

Abstract

Coronary artery disease (CAD) has an important impact on the morbidity and mortality in the West and health service
resources worldwide. It is therefore crucial to accurately diagnose CAD early, in an attempt to limit its burden on patients
and society, potentially by optimum risk stratification, accurate diagnosis and management. Invasive coronary angiography
(ICA) is the conventional gold standard imaging investigation for the coronary circulation and assessment of disease severity.
However, it is an invasive procedure and is associated with risks, although rare. In addition, it detects luminal stenosis but
not the functional importance of those anatomical lesions. Therefore, a wide variety of non-invasive imaging developed
to evaluate the presence and severity of CAD, including anatomical techniques e.g. coronary CT that assesses coronary
stenosis, and quantifies coronary calcium, hence the burden of atherosclerotic plaques and functional imaging e.g. stress
echocardiography, nuclear imaging by SPECT and PET and stress CMR. Selection of the most appropriate imaging,
therefore, is challenging and requires knowledge of patients’ pre-test probability and prevalence of disease, their advantages
and limitations, cost and availability. This review attempts to provide an overview of the current supporting evidence of the
role of non-invasive imaging in diagnosing CAD, in addition to its prognostic value, limitations and advantages.