ReviewsThe diagnostic process of stable angina still many doubts since Heberden's first description 250 years agoRaso, Irenea; Passarelli, Ilariaa; Valenti, Gioacchinoa; Crimi, Gabrielea; de Servi, StefanobAuthor Information aS.C. Cardiologia, Fondazione IRCCS Policlinico San Matteo, Pavia bS.C. Cardiologia, IRCCS Multimedica, Milan, Italy Correspondence to Prof Stefano de Servi, MD, S.C. Cardiologia, IRCCS Multimedica, Via Milanese, 300, Sesto San Giovanni, 20099 Milan, Italy Tel: +39 02 242091; e-mail: [email protected] Received 20 June, 2017 Revised 12 August, 2017 Accepted 21 August, 2017 Journal of Cardiovascular Medicine: February 2018 - Volume 19 - Issue 2 - p 45-50 doi: 10.2459/JCM.0000000000000610 Buy Metrics Abstract Since Heberden's first description, stable angina has represented a challenge for the clinicians. Even the most recent guidelines seem ineffective to correctly identify patients who should be sent to cath labs. Still too many patients who undergo coronary angiography are found not to have significant lesions; moreover, its extensive use as the first diagnostic test leads to revascularizations with uncertain appropriateness and prognostic significance. These considerations underline the importance of noninvasive testing before sending patients to invasive coronary angiography. However, it is still debatable whether it is better to pursue anatomic evaluation of the coronary tree with the use of computed tomography or assessment of myocardial ischemia, a controversy which has not been resolved by recent trials comparing the two diagnostic modalities. A combined approach using both functional and anatomic testing may lead to a more careful risk stratification before invasive coronary angiography. The aim of this article is to discuss the most recent evidence in this field, and its application in clinical practice. © 2018 Italian Federation of Cardiology. All rights reserved.