Cardiac Imaging as a Guide for Revascularization and Medical Management of Chronic Coronary Artery Disease

There is a strong association between obstructive coronary artery disease (CAD) and adverse outcomes. There is an ongoing debate regarding the role of revascularization and maximal medical therapy in patients with obstructive CAD and noninvasive imaging is recognized as a key player in guiding downstream clinical decision making especially in stable patients with known or suspected CAD. Most often risk stratification is performed with noninvasive imaging techniques including echocardiography, coronary CT angiography, single photon emission computed tomography myocardial perfusion imaging (SPECT-MPI), positron emission computed tomography-based myocardial perfusion imaging (PET-MPI), and magnetic resonance imaging (MRI). Occasionally, risk stratification may be performed with invasive angiography. In this review, we will describe some of the evidence in favor of noninvasive anatomy (CCTA) and physiology-based techniques (SPECT-MPI, PET-MPI, MRI) in guiding the choice of treatment with revascularization vs medical therapy in patients with CAD.