Diagnostic algorithms in patients with chronic coronary syndromes — what does clinical practice show?

Abstract

The European Society of Cardiology (ESC) 2019 guidelines propose a novel diagnostic algorithm for examining stable patients with suspected coronary artery disease (CAD). In retrospective analysis of previous studies, a new pretest probability scale was validated and a method for assessing clinical probability of obstructive CAD was proposed, taking into account risk factors and coronary artery calcium score. The results were studied in the EURECA multicenter registry, and the ESC-2019 diagnostic algorithm was compared with other known algorithms. The review details the results of these recently published studies, emphasizing the role of calcium score assessment in identifying low-risk patients for obstructive CAD. The review also considers publications using computed tomography coronary angiography as a "gatekeeper" among patients selected for invasive coronary angiography. The results obtained showed the effectiveness of novel diagnostic strategies in increasing the detection rate of obstructive CAD. However, clinical outcomes of any diagnostic algorithm are few and require further study, as well as their cost-effectiveness.