Description
Coronary artery disease (CAD) remains a leading cause of morbidity and mortality worldwide. Management begins with optimal medical therapy, including antiplatelets, statins, beta-blockers, ACE inhibitors, and lifestyle modification to reduce risk factors. For patients with persistent symptoms or high-risk anatomy, revascularization is considered. Percutaneous coronary intervention (PCI) with stent placement provides symptom relief and improved outcomes in acute coronary syndromes, while coronary artery bypass grafting (CABG) is favored in multivessel or complex disease. Modern care integrates individualized risk assessment, imaging, and pharmacotherapy, emphasizing a multidisciplinary heart team approach to optimize long-term prognosis and quality of life.
Summary Listen
- Coronary artery disease (CAD) prevalence varies globally, with higher rates in North Africa, the Middle East, and Russia, while North America, Western Europe, and Australia have lower rates. In the US, nearly 20 million people have CAD, and its prevalence is influenced by age and gender. Despite a decline in CAD-related deaths, it remains a leading cause of mortality.
- CAD encompasses a spectrum of diseases, including stable angina and acute coronary syndromes like unstable angina, NSTEMI, and STEMI. Pathophysiology involves structural and functional mechanisms of myocardial ischemia, both epicardial and microvascular. Diagnosis depends on clinical likelihood, employing functional imaging (PET, SPECT, stress MRI/echo) or coronary CT angiography.
- Guideline-directed medical therapy (GDMT) is the cornerstone of CAD management. Key elements include personalized goal-setting, cardiovascular risk assessment, symptom management, patient preferences, and consideration of risk-benefit ratios. Lifestyle modifications, including nutrition, physical activity, and tobacco cessation, are crucial.
- Team-based care involving cardiologists, dietitians, nurses, physiotherapists, social workers, pharmacists, and other specialists is essential. Antiplatelet therapy, lipid-lowering agents, and symptom-relieving medications like beta-blockers, calcium channel blockers, and nitrates are commonly used.
- Lifestyle modifications include adopting heart-healthy diets rich in vegetables, fruits, whole grains, and lean protein, while limiting saturated and trans fats, sodium, processed foods, and sugary drinks. Tobacco cessation, limited alcohol consumption, and regular exercise are also vital.
- Invasive treatments such as coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are considered for patients with high-risk characteristics or those unresponsive to medical therapy. CABG may be preferred for multi-vessel disease, left main disease, and patients with diabetes or ventricular dysfunction.
- The coronary sinus reducer is a device that can be implanted to improve myocardial perfusion in patients with refractory angina. Non-obstructive CAD requires individualized treatment strategies based on underlying mechanisms like microvascular dysfunction or endothelial dysfunction.
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About the Speakers
Dr Argyrios S. Ntalianis
Consultant in Cardiology & Interventional Cardiology Head of the CAD and Cardiomyopathy Unit Alexandra Hospital, Athens, Greece
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