Boden, W. E. et al. (2023) Evolving management paradigm for stable ischemic heart disease patients: JACC review topic of the week. Journal of the American College of Cardiology, 81(5), pp. 505-514. (doi: 10.1016/j.jacc.2022.08.814) (PMID:36725179)
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Abstract
Management of stable coronary artery disease (CAD) has been based on the assumption that flow-limiting atherosclerotic obstructions are the proximate cause of angina and myocardial ischemia in most patients and represent an important target for revascularization. However, the role of revascularization in reducing long-term cardiac events in these patients has been limited mainly to those with left main disease, 3-vessel disease with diabetes, or decreased ejection fraction. Mounting evidence indicates that nonepicardial coronary causes of angina and ischemia, including coronary microvascular dysfunction, vasospastic disorders, and derangements of myocardial metabolism, are more prevalent than flow-limiting stenoses, raising concerns that many important causes other than epicardial CAD are neither considered nor probed diagnostically. There is a need for a more inclusive management paradigm that uncouples the singular association between epicardial CAD and revascularization and better aligns diagnostic approaches that tailor treatment to the underlying mechanisms and precipitants of angina and ischemia in contemporary clinical practice.
| Item Type: | Articles |
|---|---|
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Berry, Professor Colin |
| Authors: | Boden, W. E., Marzilli, M., Crea, F., Mancini, G.B. J., Weintraub, W. S., Taqueti, V. R., Pepine, C. J., Escaned, J., Al-Lamee, R., Gowdak, L. H. W., Berry, C., and Kaski, J. C. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health |
| Journal Name: | Journal of the American College of Cardiology |
| Publisher: | Elsevier |
| ISSN: | 0735-1097 |
| ISSN (Online): | 1558-3597 |
| Published Online: | 30 January 2023 |
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