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Making a diagnosis of stable angina (coronary artery disease (CAD)) - what investigations are required

Authoring team

  • making a diagnosis following investigations
    • confirm a diagnosis of stable angina and follow local guidelines for angina when:
      • significant CAD (see box 1) is found during invasive or 64-slice (or above) CT coronary angiography and/or
      • reversible myocardial ischaemia is found during non-invasive functional imaging

Box 1 :Definition of significant coronary artery disease

  • significant coronary artery disease (CAD) found during invasive coronary angiography is >=70% diameter stenosis of at least one major epicardial artery segment or >=50% diameter stenosis in the left main coronary artery:
    • factors intensifying ischaemia. Such factors allow less severe lesions (for example >=50%) to produce angina:
      • reduced oxygen delivery: anaemia, coronary spasm
      • increased oxygen demand: tachycardia, left ventricular hypertrophy
      • large mass of ischaemic myocardium: proximally located lesions
      • longer lesion length
    • factors reducing ischaemia. Such factors may render severe lesions (>=70%) asymptomatic:
      • well developed collateral supply
      • small mass of ischaemic myocardium: distally located lesions, old infarction in the territory of coronary supply
  • investigate other causes of chest pain when:
    • significant CAD (see box 1) is not found during invasive coronary angiography or 64-slice (or above) CT coronary angiography and/or
    • reversible myocardial ischaemia is not found during non-invasive functional imaging or
    • the calcium score is zero
  • consider investigating other causes of angina, such as hypertrophic cardiomyopathy or syndrome X, in people with typical angina-like chest pain if investigation excludes flow-limiting disease in the epicardial coronary arteries.

Reference:

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