Non-invasive Risk Stratification for Coronary Artery Disease: Is It Time for Subclassifications?

Pupalan Iyngkaran, Samer Noaman, William Chan, Gnanadevan Mahadavan, Merlin C. Thomas, Sharmalar Rajendran

Research output: Contribution to journalReview ArticleResearchpeer-review

1 Citation (Scopus)


Purpose of Review: Coronary artery disease (CAD) is the leading contributor to cardiovascular disease; it is the most prevalent non-communicable disease globally and has high morbidity, mortality and health care cost. Risk stratification is defined as prevention or containment of disease prior to it occurring or progressing, and non-invasive surrogates include history, examination, biomarkers and non-invasive imaging. This review aims to highlight advancement in current diagnostic strategies and explores gaps for CAD secondary to atherosclerosis and non-obstructive vascular diseases. Recent Findings: Cardiac risk scores have largely proven inadequate in risk stratifying heterogeneous patient populations. Greater emphasis should also be provided to posttest risk stratification. Non-invasive imaging with MRI is the most accurate but least cost efficacious presently due to availability and expertise. Echocardiography and nuclear imaging have good accuracy, but radiation limits the latter. Novel echocardiographic technologies may increase its appeal. Cardiac CT angiography is increasingly promising. Summary: Non-invasive and minimally invasive imaging has significantly influenced the cost-efficacy trajectory of coronary artery disease diagnosis and management. Recent studies suggest that future guidelines will incorporate more subclassifications from the findings of these novel technologies and for more diverse patient demographics.

Original languageEnglish
Article number87
Number of pages10
JournalCurrent Cardiology Reports
Issue number8
Publication statusPublished - 1 Aug 2019
Externally publishedYes


  • Coronary artery disease
  • Cost efficacy
  • Minimal invasive imaging
  • Non-invasive imaging
  • Risk score
  • Risk stratification
  • Screening

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