The problem with such models is that they do not prove that the chest discomfort in the patient is actually as a result of the coronary atheroma found at angiography. Atheroma can be asymptomatic, and we as cardiologists know from the cath lab that the relationship between degree of stenosis and symptoms in patients is highly variable.

Thus, when using your on-line calculator, a 60 year old man with typical pain and no risk factors has roughly the same risk of coronary disease as a man of the same age with a full house of risk factors but with non-specific pain.

Does this then mean that both men require revascularisation? It might be that first man does, but the second might perhaps benefit more from good primary prevention medication and a re-assessment of what his symptoms actually represent.

Competing interests: None declared