Intuitively, the most accurate way to diagnose coronary artery disease is by direct visualization of coronary atherosclerosis; the gold standard to localize coronary lesions is invasive coronary angiography (ICA). However, in practice, ICA is not used routinely as the first-line investigation because it is invasive, costly, and risky and because anatomic measures of coronary atherosclerosis have limitations in delineating the physiologic implications of coronary diseases. Thus, diagnosis of coronary artery disease has focused on the detection of myocardial ischemia (ie, physiologic manifestations) instead of the coronary lesions per se (ie, anatomic evidence), and ICA has been reserved for confirmation of high-risk anatomy in patients who may benefit from revascularization. The recent introduction of multidetector computed tomographic angiography (CTA) has allowed noninvasive, high-resolution imaging of the coronary arteries, challenging the traditional function-based diagnostic approach to the detection of coronary artery disease.
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— Pui-Wai Lee, MBChB, Patricia A. Pellikka, MD
This article was originally published in the May 2008 issue of the American Journal of Medicine.
