Almanac 2011: stable coronary artery disease. The national society journals present selected research that has driven recent advances in clinical cardiology

The widespread application of specialist clinics for early evaluation of patients with chest pain has focused attention on the effectiveness of diagnostic testing. In a study of nearly 400,000 patients with suspected coronary artery disease, the diagnostic yield of cardiac catheterisation was only 37.6%, leading to calls for better strategies for risk stratification.1 As pointed out in correspondence, the low yield was likely due to verification bias, itself a consequence of basing referral decisions in low risk populations on non-invasive tests such as the exercise ECG.2 It was similar considerations that prompted recent guideline recommendations for a more selective approach to non-invasive testing based on a careful clinical assessment of disease probability in patients presenting with stable chest pain.3 For those, with unequivocal histories at the extremes of diagnostic probability (<10% or >90%) no diagnostic tests were considered necessary, while for patients with a high probability of disease (60% to 90%) invasive angiography without prior ischaemia testing was the recommendation. The call for CT calcium scoring in patients with a low (10% to 30%) probability of disease generated particular concern after a recent study