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Chronic Coronary Syndrome — EECC MCQ

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EasyCoronary Artery DiseaseChronic Coronary SyndromeEECC

A 55-year-old man is seen in the chest pain clinic with a 4-month history of predictable exertional chest tightness relieved by rest. He has a pre-test probability of obstructive coronary artery disease estimated at 25%. Resting ECG is normal. What is the most appropriate first-line investigation?

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Correct answer: C — CT coronary angiography

Explanation lettering: C = shown as A · A = shown as C

The 2024 ESC CCS Guidelines recommend CTCA as the preferred initial non-invasive test for patients with low-to-intermediate pre-test probability of obstructive CAD, due to its high negative predictive value. Exercise ECG (B) is no longer recommended as a first-line diagnostic test. Invasive coronary angiography (A) is not appropriate first-line. Stress CMR (D) and stress echo (E) are alternatives but CTCA is preferred in this pre-test probability range.

Reference: ESC (2024): Guidelines for the Management of Chronic Coronary Syndromes