Angina diagnostics — the cardiovascular testing modalities including stress testing, nuclear perfusion imaging, cardiac CT, and coronary physiology assessment used to diagnose, risk-stratify, and guide management of angina — create an important market dimension, with the Angina Market reflecting diagnosis as commercially integral to the total angina market.

Coronary CT angiography (CCTA) has transformed stable chest pain evaluation as the preferred first-line investigation in European guidelines (ESC 2019 Chronic Coronary Syndrome guidelines) and increasingly in US guidelines. The PROMISE trial demonstrating CCTA's efficiency advantage over functional testing for stable chest pain evaluation has driven CCTA adoption for initial angina evaluation, creating demand for advanced CT scanner capability and CCTA interpretation services.

Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) — the coronary physiology measurements determining hemodynamic significance of stenoses identified on angiography — represent the functional assessment market embedded within the interventional cardiology workflow. The FAME and DEFINE-FLAIR trials demonstrating FFR and iFR-guided PCI achieving superior outcomes versus angiography-guided PCI have established physiologic assessment as clinical standard, creating the pressure wire consumable market.

Nuclear stress testing (SPECT, PET) for myocardial perfusion imaging maintains its role in complex chest pain evaluation, risk stratification before revascularization, and viability assessment. PET's superior image quality and quantitative coronary flow reserve measurement creating the premium nuclear cardiology tier that SPECT cannot match.

Do you think CCTA will eventually replace most functional stress testing for stable angina evaluation, given its superior anatomical information and guideline support in Europe?

FAQ

What is the preferred diagnostic approach for new stable chest pain? European ESC guidelines recommend CCTA as preferred first investigation for new stable chest pain in intermediate pre-test probability; US ACC/AHA guidelines recommend functional testing (stress ECG, imaging stress test) or CCTA depending on clinical factors.

What is FFR and why does it matter in angina management? Fractional Flow Reserve measures the hemodynamic significance of coronary stenosis during catheterization using a pressure wire; FFR-guided PCI showing superior outcomes versus angiography guidance creates functional assessment as clinical standard before stent placement.

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