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

Last reviewed 04/2021

• 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:

• 1) NICE (March 2010). Chest pain of recent onset.