Initial diagnostic management of patients with suspected SCAD
This dynamic protocol provides a stepwise approach for decision-making in patients with suspected stable coronary artery disease (SCAD), based on the ESC 2013 guidline 'Stable coronary artery disease'.
Research authors: 2013 ESC guideline - Management of stable coronary artery disease (SCAD).
Details Decision tree Files & References
Sequential
Model author
Version
1.72
Revision date
2018-08-30
Specialty
MeSH terms
  • Cardiology
  • Angina, Stable
  • Guideline
  • Status
    public
    Share
            • Offer invasive coronary angiography
              Offer invasive coronary angiography if revascularization is suitable.
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
            • Low pre-test probability (<15%)
              Consider functional coronary artery disease.
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
              • Trial of OMT
                A trial of optimal medical therapy is recommended.
              • OMT and consider ICA
                Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
              • ICA + OMT
                Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
        • Treat as appropriate
          Other diagnostic testing may be indicated to identify gastrointestinal, pulmonary or musculoskeletal causes.
      • Indication for medical therapy
        Establishing a diagnosis using pharmacologic stress imaging prior to treatment may be reasonable.

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            • Offer invasive coronary angiography
              Offer invasive coronary angiography if revascularization is suitable.
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
            • Low pre-test probability (<15%)
              Consider functional coronary artery disease.
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
                • Additional testing is required
                  Please perform additional testing based on patient characteristics and preferences.
                • Consider functional CAD
                  Consider functional coronary artery disease (CAD) and investigate other causes.
                  • Trial of OMT
                    A trial of optimal medical therapy is recommended.
                  • OMT and consider ICA
                    Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
                  • ICA + OMT
                    Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
              • Trial of OMT
                A trial of optimal medical therapy is recommended.
              • OMT and consider ICA
                Invasive coronary angiography should be considered based on co-morbilities and patient preferences.
              • ICA + OMT
                Perform invasive coronary angiography (+ FFR when required) (+ revascularization when appropriate) + OMT
        • Treat as appropriate
          Other diagnostic testing may be indicated to identify gastrointestinal, pulmonary or musculoskeletal causes.
      • Indication for medical therapy
        Establishing a diagnosis using pharmacologic stress imaging prior to treatment may be reasonable.
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