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Contemporary Management of Stable Coronary Artery Disease.

Dario Tino BertoloneEmanuele GallinoroGiuseppe EspositoPasquale PaolissoKonstantinos BermpeisCristina De ColleDavide FabbricatoreNiya MilevaChiara ValerianoDaniel MunhozMarta BelmonteMarc VanderheydenJozef BartunekJeroen SonckEric WyffelsCarlos ColletCostantino MancusiCarmine MoriscoNicola De LucaBernard De BruyneEmanuele Barbato
Published in: High blood pressure & cardiovascular prevention : the official journal of the Italian Society of Hypertension (2022)
Coronary artery disease (CAD) continues to be the leading cause of mortality and morbidity in developed countries. Assessment of pre-test probability (PTP) based on patient's characteristics, gender and symptoms, help to identify more accurate patient's clinical likelihood of coronary artery disease. Consequently, non-invasive imaging tests are performed more appropriately to rule in or rule out CAD rather than invasive coronary angiography (ICA). Coronary computed tomography angiography (CCTA) is the first-line non-invasive imaging technique in patients with suspected CAD and could be used to plan and guide coronary intervention. Invasive coronary angiography remains the gold-standard method for the identification and characterization of coronary artery stenosis. However, it is recommended in patients where the imaging tests are non-conclusive, and the clinical likelihood is very high, remembering that in clinical practice, approximately 30 to 70% of patients with symptoms and/or signs of ischemia, referred to coronary angiography, have non obstructive coronary artery disease (INOCA). In this contest, physiology and imaging-guided revascularization represent the cornerstone of contemporary management of chronic coronary syndromes (CCS) patients allowing us to focus specifically on ischemia-inducing stenoses. Finally, we also discuss contemporary medical therapeutic approach for secondary prevention. The aim of this review is to provide an updated diagnostic and therapeutic approach for the management of patients with stable coronary artery disease.
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