Review compares ESC and ACC/AHA imaging guidance for chronic coronary disease

A review in the European Heart Journal – Cardiovascular Imaging compares contemporary European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) recommendations for non-invasive imaging in chronic coronary disease and syndromes. It examines guidance on diagnosis, risk stratification, follow-up, and management rather than reporting a new patient cohort or clinical outcomes.

Both guidelines support assessing clinical likelihood before testing, selectively using coronary computed tomography angiography (CCTA) and functional imaging, and avoiding routine surveillance testing in clinically stable patients. The ESC guideline offers a more prescriptive pathway for suspected chronic coronary syndromes, with pre-test likelihood thresholds guiding test deferral, CCTA, functional imaging, or invasive angiography. It also gives CCTA a stronger early role in patients with low-to-moderate likelihood and specifies more high-risk anatomical and ischaemic imaging thresholds.

The ACC/AHA guideline focuses more on established disease, symptom changes, functional decline, and whether testing would alter management. Other differences concern exercise electrocardiography and assessment of non-obstructive coronary syndromes, including microvascular and vasospastic angina. These distinctions may affect test selection and repeat testing, but the abstract does not establish that either approach improves outcomes. Full text was unavailable, and the abstract does not provide the specific recommendation classes or numerical thresholds.