In evaluating suspected CAD, which test is considered definitive?

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Direct visualization of the coronary arteries is what confirms CAD. Cardiac catheterization with coronary angiography injects contrast into the coronary vessels and provides real-time images of the lumen, allowing precise assessment of the presence, location, and degree of stenosis. This anatomical detail is why it’s considered definitive for diagnosing CAD and planning treatment, including potential interventions like angioplasty or stenting.

Noninvasive tests such as ambulatory EKG monitoring, exercise treadmill testing, or nuclear perfusion imaging assess ischemia or perfusion abnormalities and help with risk stratification, but they do not reveal the exact coronary anatomy or the precise severity of blockages. They’re useful screening and functional assessment tools, often guiding the decision to proceed to invasive angiography.