Peer-review started: June 6, 2018
First decision: June 6, 2018
Revised: August 15, 2018
Accepted: December 24, 2018
Article in press: December 24, 2018
Published online: January 18, 2019
Coronary artery disease (CAD) screening and diagnosis are core cardiac specialty services. From symptoms, autopsy correlations supported reductions in coronary blood flow and dynamic epicardial and microcirculatory coronaries artery disease as etiologies. While angina remains a clinical diagnosis, most cases require correlation with a diagnostic modality. At the onset of the evidence building process much research, now factored into guidelines were conducted among population and demographics that were homogenous and often prior to newer technologies being available. Today we see a more diverse multi-ethnic population whose characteristics and risks may not consistently match the populations from which guideline evidence is derived. While it would seem very unlikely that for the majority, scientific arguments against guidelines would differ, however from a translational perspective, there will be populations who differ and importantly there are cost-efficacy questions, e.g., the most suitable first-line tests or what parameters equate to an adequate test. This article reviews non-invasive diagnosis of CAD within the context of multi-ethnic patient populations.
Core tip: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Globalisation has seen an epidemiological shift in demographics and risk for populations. In planning a cost-effective health service it is important to understand demographic risk and variables in interpretating and managing CAD.