Normal view MARC view ISBD view

Evolving Management Paradigm for Stable Ischemic Heart Disease Patients: JACC Review Topic of the Week. [Review]

MedStar author(s):

Citation: Journal of the American College of Cardiology. 81(5):505-514, 2023 Feb 07.PMID: 36725179Institution: MedStar Health Research InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Coronary Artery Disease | *Myocardial Ischemia | *Vascular Diseases | Angina Pectoris | Coronary Artery Disease/co [Complications] | Coronary Artery Disease/di [Diagnosis] | Coronary Artery Disease/th [Therapy] | Humans | Myocardial Ischemia/di [Diagnosis] | Myocardial Ischemia/ep [Epidemiology] | Myocardial Ischemia/th [Therapy] | Vascular Diseases/co [Complications]Year: 2023 Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:

0735-1097

Name of journal: Journal of the American College of CardiologyAbstract: 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. Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.All authors: Boden WE, Marzilli M, Crea F, Mancini GBJ, Weintraub WS, Taqueti VR, Pepine CJ, Escaned J, Al-Lamee R, Gowdak LHW, Berry C, Kaski JCFiscal year: FY2023 Digital Object Identifier:

https://dx.doi.org/10.1016/j.jacc.2022.08.814

Date added to catalog: 2023-04-11

Holdings ( 1 )
Title notes ( 3 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article		Available

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

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. Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

English