Challenges of Diagnosis of Obstructive Coronary Artery Disease: The Role of Non-Invasive Testing

High mortality from cardiovascular diseases, especially coronary artery disease (CAD), represents a major economic burden on healthcare systems. The number of diagnostic coronary angiographies (CAG) is increasing in the Russian Federation. However, routine invasive CAG is not able to determine obstructive coronary artery disease in a considerable number of patients. The rate of intact coronary arteries reaches 42% in the major registries and accounts for 37.9% in our Research Institute. Despite all improvements in the diagnostic algorithms focused on suspected coronary artery disease, stated in the recent international and national guidelines, and the availability of advanced non-invasive diagnostic methods, they do not improve accurate CAG diagnosis of obstructive coronary artery disease. Moreover, the available guidelines contain many contradictions. Therefore, an optimal diagnostic algorithm of significant coronary artery lesions is a subject of discussion. The proposed review discusses all discrepancies concerning the assessment of the pretest probability as well as the proposed non-invasive testing. In addition, the preferred use of non-invasive tests with anatomical assessment (i.e. multispiral computed tomography coronary imaging) rather than functional tests with visualization is stated. This review ensures better understanding of diagnostic strategies for stable coronary artery disease used both in researches and in clinical practice.