Coronary Artery disease: New Way of Thinking


The way we think about Coronary Artery Disease (CAD) and its treatment has experienced a significant change. Today, some cardiologists have completely changed to the “new way” of thinking, while others still get stuck in the “traditional way.”

The traditional way of thinking about Coronary artery disease (CAD)

Traditionally, CAD means there are one or more blockages in the coronary arteries which can reduce blood flow. This situation can lead to angina (chest discomfort), and, if it gets worse, the blockages can suddenly become complete, causing the heart muscle supplied by that artery to die, which is known as a “myocardial infarction” or “heart attack”. At that time, most of the people claim that the crucial problem is the blockage, so the most of the treatment is to ease the blockage. Such treatments can be done as bypass surgery or stenting.

Because of the traditional view of CAD, which focuses on blockages, the critical aspects in assessing CAD  are precise anatomic location and degree of blockages. This is highlighted that if diagnostic tests do not provide this information and treatments do not reduce the blockages, they are not fully adequate.

In addition, cardiologists who think traditionally are more likely to insist on cardiac catheterizations as the main or even only adequate diagnostic test.  This leads to the fact that they tend to hold the view that stenting is the only adequate therapy. Although sometimes they will reluctantly allow that the cardiac surgeon needs to get involved for particularly extensive or difficult blockages.

The new way of thinking about Coronary artery disease (CAD)

Thanks to the development of technology, we now know that CAD is about far more than just blockages. CAD is known as a chronic, progressive disease that is more likely to be far more widespread within the coronary arteries than is implied by the presence or absence of actual blockages. It is important to know that plaques are often present in arteries. It can appear “normal” on cardiac catheterization. But the fact is that some patients, especially women, may experience widespread CAD that produces a generalized narrowing of the coronary arteries without having any actual blockages. In addition, when a plaque ruptures and causes a clot to form, that suddenly blocks the artery and can lead to heart attacks. The crucial aspect of CAD is not whether specific blockages are present or absent, but it lies in the fact that whether coronary artery plaques (which often do not cause significant blockages) are present.

Over the past decade or so, our thinking about CAD has turned from a disease of blockages that should be treated with stents into halting or reversing chronic CAD and at stabilizing plaques whether “significant” blockages are present or not.

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