coronary artery disease; coronary atherosclerosis (CAD)
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Introduction
Atherosclerotic narrowing of the major epicardial coronary arteries. (A number of disease processes other than atherosclerosis can involve coronary arteries.)
Etiology
(Risk factors)*
- male age > 45 years
- female age > 55 years
- estrogen deficiency
- elevated LDL cholesterol (> 160 mg/dL)
- low HDL cholesterol (< 35 mg/dL)
- smoking
- hypertension
- elevated homocysteine
- elevated insulin
- diabetes mellitus
- much greater risk factor than hypertension or dyslipidemia[2]
- non-coronary athersclerosis[4]
- elevated C-reactive protein
- sleep deprivation may play role[16]
- radiation therapy to the thorax (Hodgkin's disease)[2]
* also see cardiac risk factor
Epidemiology
- declining rate of death from coronary artery disease due to primary prevention[10], secondary prevention[19] & in coronary care[19]
- identified in 34% of mummies from 4 geographical regions, including ancient Egypt & Peru[24]
- Tsimane, an indigenous group living a pre-industrial lifestyle in the Bolivian Amazon with low incidence of coronary artery disease[50]
Pathology
- atherosclerosis with occlusion of coronary arteries
- anatomic burden (degree of coronary artery occlusion) & LVEF better predict outcomes than ischemic burden (measured during stress testing) or initial treatment (medical therapy vs PCI)[29]
- increased plasma levels of trimethylamine N-oxide associated with increased mortality in patients with stable CAD[45]
- inflammation contributes to both the formation of arterial plaques & their destabilization[54]
Genetics
- most cases NOT genetically determined[12]
- implicated genes: TERT, ITGA2, ZC3H12A
Laboratory
- lipid panel
- coronary artery disease 23 mRNA expression analysis[43]
- gene expression model not yet useful[17]
- see ARUP consult[21]
Diagnostic procedures
- exercise tolerance testing*
- dobutamine stress echocardiography*
- 6 minute walk[20]
- other tests may be useful
- exercise stress echocardiography
- dobutamine myocardial perfusion study
- coronary angiography
- fractional flow reserve measurement during coronary angiography is superior to angiography alone for guiding percutaneous coronary intervention (PCI) in patients with severe but stable CAD[33]
- insufficient evidence to recommend for or against screening in higher-risk patients[6]
- routine screening in asymptomatic patients with diabetes mellitus does not reduce mortality[2]
* see stress testing & imaging findings associated with poor prognosis
# overall costs similar with imaging vs functional testing in patients with stable chest pain[40]
Radiology
- cardiac CT angiography* may be best initial test[65]
- other potentially useful tests
* positive cardiac CT angiography in women more predictive of adverse cardiovascular events than in men[38]
* cardiac CT angiography associated with lower risk for myocardial infarction but not mortality compared with exercise stress testing[54]
* perivascular fat attenuation index measured with cardiac CT angiography may be useful for assessing coronary artery inflammation[54]
* associated with fewer angiograms (RR=0.23) & revascularizations (RR=0.71), but similar rates of myocardial infarction (MI) & cardiovascular(CV)-related death, than direct referral for angiography[65]
* cardiac CT angiography associated with fewer MI & CV-related deaths than exercise electrocardiography (RR=0.66) or SPECT-MPI (RR=0.64) but was associated with more revascularizations secondary to the index text than was exercise electrocardiography (RR=1.78)[65]
* cardiac magnetic resonance imaging with better diagnostic accuracy than myocardial perfusion imaging with SPECT[39]
* cardiac magnetic resonance imaging & myocardial perfusion scintigraphy may avoid unnecessary coronary angiography[42]
Complications
- myocardial infarction (MI)
- the majority of myocardial infarctions are associated with non-obstructive coronary artery disease[34]
- extensive or obstructive subclinical atherosclerosis is associated with excess risk for myocardial infarction[63]
- fluctuations in body weight associated with increased risk of cardiovascular events in patients with CAD[51]
- high & low systolic blood pressure (> 140 mm Hg or < 120 mm Hg) & high & low diastolic blood pressure (> 80 mm Hg or < 70 mm Hg) associated with increased cardiovascular risk in patients with stable coronary artery disease[44]
- no increase in risk of stroke with low blood pressure
- cognitive impairment
- cognitive decline similar with CABG vs medical management[15] - cardiopulmonary bypass pump not a factor[32]
- patients with LV ejection fraction > 50% more likely to die of cause other than sudden cardiac death due to arrhythmia[57]
- disease interaction(s) of coronary artery disease with anemia
- disease interaction(s) of atrial fibrillation with coronary artery disease
Management
- pharmacologic agents
- antihypertensive agents
- goals
- beta-blocker for HFrEF or angina pectoris[66]
- target heart rate 55-60/min & ~75% of heart rate that produces angina pectoris on exertion[2]
- does not reduce risk of cardiovascular events[22]
- except after myocardial infarction
- nitrates
- Ca+2 channel blockers
- reactive airway disease intolerant to beta-blockers
- brittle diabetic with episodes of severe hypoglycemia
- patients in whom beta-blockers cause intolerable fatigue or depression
- renin-angiotensin system inhibitors (ACE inhibitors/ARBs)
- in patients with impaired left-ventricular function (LVEF < 35%)
- may be beneficial for all patients with CAD (see EUROPA trial)
- no added benefit for low-risk patients (PEACE trial)
- no convincing evidence of benefit in patients with stable coronary artery disease without heart failure[58]
- antiplatelet agent(s)
- aspirin 81-325 mg QD or 325 mg QOD may risk of cardiovascular events risk of cardiovascular events
- clopidogrel for aspirin failure
- Aggrenox
- addition of aspirin to warfarin may not reduce risk of myocardial infarction in patients with coronary artery disease[35]
- no data after cororary revascularization
- aspirin 100 mg QD + rivaroxaban 2.5 mg BID reduces risk of cardiovascular events (4.1% vs 5.4% for aspirin alone)[52]
- lipid-lowering agents (statins)
- high-intensity statin (all patients <= 75 years of age)
- ezetimibe 10 plus moderate intensity statin (10 mg rosuvastatin) may be alternative in patients intolerant of high intensity statin[67]
- add ezetimibe 10 mg or PCSK9 inhibitor to high intensity statin to achieve LDL cholesterol < 70 mg/dL[66]
- MKSAP favors ezetimibe over PCSK9 inhibitor
- goal of LDL cholesterol < 100 mg/dL & < 70 mg/dL in high-risk patients[8]
- intensive lipid-lowering therapy of LDL cholesterol to < 70 mg/dL slows atherosclerotic plaque progression assessed by CT angiography[46]
- treat-to-target LDL cholesterol strategy of 50-70 mg/dL as the goal is noninferior to a high-intensity statin therapy for 3-year composite of death, myocardial infarction, stroke, or coronary revascularization[62]
- intensive lipid-lowering therapy to very low LDL cholesterol levels is not associated with diminished mortality[47][48]
- statin use associated with transformation of coronary atherosclerosis toward high-density calcification & slower plaque progression[61]
- SGLT-2 inhibitors for patients with diabetes mellitus type 2 or HFrEF[66]
- colchicine 0.5 mg/day FDA approved
- may lower risk of cardiovascular events[60] at the cost of increased mortality
- reduces cardiovascular mortality[64]
- ranolazine if other options exhausted[2]
- antihypertensive agents
- revascularization procedures
- indications
- impaired left ventricular function with > 50% stenosis in a major coronary vessel with evidence of myocardial viability in areas or reduced wall motion (by stress MIBI)
- improves 10 year survival in patients with severe LV dysfunction[2]
- normal left ventricular function with left main, 3 vessel or severe 2 vessel coronary disease
- left main or multivessel disease with involvement of proximal left anterior descending artery & LV systolic dysfunction[2]
- age is NOT a contraindication
- revascularization improves morbidity & mortality at 6 months in patients > 75 years of age[5]
- optimize medical therapy prior to consideration of revascularization[2]
- impaired left ventricular function with > 50% stenosis in a major coronary vessel with evidence of myocardial viability in areas or reduced wall motion (by stress MIBI)
- percutaneous coronary intervention (PCI)
- improves symptoms of stable angina[2]
- 5 year relief of angina with PCI somewhat < with CABG
- does not improve survival or reduce future cardiovascular events[2]
- stenting diminishes restenosis
- may be preferable to CABG even in patients with diabetes[2]
- for percutaneous coronary intervention in patients anticoagulated for atrial fibrillation or venous thromboembolism, dual antiplatelet therapy is recommended for only 1-4 weeks, followed by clopidogrel for 6 months[66]
- coronary artery bypass graft (CABG)
- see Bypass Angioplasty Revascularization Investivation (BARI)
- outcomes for PCI with coronary stenting similar to CABG for left main coronary artery disease[14]
- cardiac rehabilitation after revascularization or mypcardial infarction[66]
- indications
- life style
- a healthy life style can mitigate genetic risk factors[49]
- Mediterranean diet is recommended to improve cardiovascular outcomes[66]
- supplements including omega-3 fatty acids; vitamins A, C, D, or E; & calcium are not recommended to reduce cardiovascular risk[66]
- exercise superior to angioplasty in patients with stable coronary artery disease
- patients with highest level of activity with lowest 4 year mortality[55]
- angioplasty with stenting no better than optimal medical therapy for coronary artery disease[13][59] with or without CKD
- anemia
- restrictive strategy for RBC transfusion
- erythropoiesis-stimulating agent not recommended[28]
- chelation therapy not recommended[23] (2014 ACC/AHA...)
- see screening for coronary artery disease
Notes
- lipid-lowering for secondary prevention in patients with cardiovascular disease much more effective than for primary prevention[2]
- optimal medical therapy underutilized[18]
- comprehensive guidelines for diagnosis & management of ischemic heart disease, including algorythms[23]
More general terms
More specific terms
- angina & no obstructive coronary artery disease (ANOCA)
- angiographically significant coronary artery disease (CAD)
- coronary artery stenosis
- coronary thrombus
- inherited form of coronary artery disease
- left main coronary artery disease
- multivessel disease
- post cardiac transplant coronary artery disease
- Wellens' syndrome
Additional terms
- acute coronary syndrome; unstable angina (ACS)
- cardiovascular risk factor
- chronic stable angina
- coronary artery
- coronary stent/coronary stenting
- coronary syndrome X (microvascular angina)
- factors associated with poor prognosis in patients with CAD
- secondary prevention in patients with cardiovascular disease
References
- ↑ Stedman's Medical Dictionary 27th ed, Williams & Wilkins, Baltimore, 1999.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17. 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018, 2022.
- ↑ Journal Watch 20(18):142, 2000 Danesh et al BMJ 321:199, 2000
- ↑ 4.0 4.1 National Cholesterol Education Program [4]
- ↑ 5.0 5.1 Journal Watch 21(21):168, 2001 The TIME investigators, Lancet 358:951, 2001 Aronow et al, Lancet 358:945, 2001
- ↑ 6.0 6.1 Moyer VA et al Screening for Coronary Heart Disease With Electrocardiography: U.S. Preventive Services Task Force Recommendation Statement Annals of Internal Medicine, July 31, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22847227 <Internet> http://annals.org/article.aspx?articleid=1262305 (corresponding NGC guideline withdrawn Feb 2018) Journal Watch 24(9):74, 2004 U.S. Preventive Services Task Force. Screening for coronary heart disease: recommendation statement. Ann Intern Med. 2004 Apr 6;140(7):569-72. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15068986
USTSTF http://www.ahrq.gov/clinic/3rduspstf/chd/chdrs.htm
Fowler-Brown A, Pignone M, Pletcher M, Tice JA, Sutton SF, Lohr KN; U.S. Preventive Services Task Force. Exercise tolerance testing to screen for coronary heart disease: a systematic review for the technical support for the U.S. Preventive Services Task Force. Ann Intern Med. 2004 Apr 6;140(7):W9-24. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15069009
Fowler-Brown A et al http://www.ahrq.gov/clinic/3rduspstf/chd/chdsum.htm - ↑ Journal Watch 24(11):88, 2004 Hambrecht R, Walther C, Mobius-Winkler S, Gielen S, Linke A, Conradi K, Erbs S, Kluge R, Kendziorra K, Sabri O, Sick P, Schuler G. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 2004 Mar 23;109(11):1371-8. Epub 2004 Mar 08. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15007010
- ↑ 8.0 8.1 Journal Watch 25(8):62, 2005 LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, Gotto AM, Greten H, Kastelein JJ, Shepherd J, Wenger NK; Treating to New Targets (TNT) Investigators. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005 Apr 7;352(14):1425-35. Epub 2005 Mar 8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15755765
Pitt B. Low-density lipoprotein cholesterol in patients with stable coronary heart disease--is it time to shift our goals? N Engl J Med. 2005 Apr 7;352(14):1483-4. Epub 2005 Mar 8. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15755764 - ↑ Mieres JH, Shaw LJ, Arai A, Budoff MJ, Flamm SD, Hundley WG, Marwick TH, Mosca L, Patel AR, Quinones MA, Redberg RF, Taubert KA, Taylor AJ, Thomas GS, Wenger NK; Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation. 2005 Feb 8;111(5):682-96. Epub 2005 Feb 1. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/15687114 <Internet> http://circ.ahajournals.org/cgi/content/full/111/5/682
- ↑ 10.0 10.1 Unal B, Critchley JA, Capewell S. Modelling the decline in coronary heart disease deaths in England and Wales, 1981-2000: comparing contributions from primary prevention and secondary prevention. BMJ. 2005 Sep 17;331(7517):614. Epub 2005 Aug 17. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16107431
- ↑ Go AS et al, Statin and beta-blocker therapy and the initial presentation of coronary artery disease. Ann Intern Med 2006; 144:229 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16490908
- ↑ 12.0 12.1 Morgan TM, Krumholz HM, Lifton RP, Spertus JA. Nonvalidation of reported genetic risk factors for acute coronary syndrome in a large-scale replication study. JAMA. 2007 Apr 11;297(14):1551-61. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17426274
- ↑ 13.0 13.1 Prescriber's Letter 14(6): 2007 PCI Plus Medical Therapy in Patients with Stable CAD Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=230622&pb=PRL (subscription needed) http://www.prescribersletter.com
Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS; COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007 Apr 12;356(15):1503-16. Epub 2007 Mar 26. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17387127 - ↑ 14.0 14.1 Seung KB, Park DW, Kim YH, Lee SW, Lee CW, Hong MK et al Stents versus coronary-artery bypass grafting for left main coronary artery disease. N Engl J Med. 2008 Apr 24;358(17):1781-92. Epub 2008 Mar 31. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18378517
Jones RH. Percutaneous intervention vs. coronary-artery bypass grafting in left main coronary disease. N Engl J Med. 2008 Apr 24;358(17):1851-3. Epub 2008 Mar 31. No abstract available. PMID: https://www.ncbi.nlm.nih.gov/pubmed/18378518 - ↑ 15.0 15.1 Selnes OA et al, Cognition 6 years after surgical or medical therapy for coronary artery disease. Ann Neurol 2008, 63:581 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18481292
Yaffe K & Covinsky KE Coronary bypass surgery and long-term cognitive decline. Ann Neurol 2008, 63:547 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18481289 - ↑ 16.0 16.1 King CR et al, Short Sleep Duration and Incident Coronary Artery Calcification JAMA. 2008;300(24):2859-2866. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19109114
- ↑ 17.0 17.1 Rosenberg S et al. Multicenter validation of the diagnostic accuracy of a blood-based gene expression test for assessing obstructive coronary artery disease in nondiabetic patients. Ann Intern Med 2010 Oct 5; 153:425. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20921541
- ↑ 18.0 18.1 Borden WB Patterns and Intensity of Medical Therapy in Patients Undergoing Percutaneous Coronary Intervention JAMA. 2011;305(18):1882-1889 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21558519
- ↑ 19.0 19.1 19.2 Schmidt M et al. 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: A Danish nationwide cohort study. BMJ 2012 Jan 25; 344:e356 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22279113
Smolina K et al. Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010: Linked national database study. BMJ 2012 Jan 25; 344:d8059 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22279113
Bandosz P et al. Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: Modelling study. BMJ 2012 Jan 25; 344:d8136 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22279114
Tunstall-Pedoe H. The decline in coronary heart disease; did it fall or was it pushed? BMJ 2012 Jan 25; 344:d7809 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22279112 - ↑ 20.0 20.1 Beatty AL et al Six-Minute Walk Test as a Prognostic Tool in Stable Coronary Heart Disease: Data From the Heart and Soul Study Arch Intern Med. 2012;():1-7, June 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22710902 <Internet> http://archinte.jamanetwork.com/article.aspx?articleID=1188037
Nash DT Time for a 6-Minute Walk?: Comment on Six-Minute Walk Test as a Prognostic Tool in Stable Coronary Heart Disease Arch Intern Med. 2012;():1-1, June 18, 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22710968 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1188039 - ↑ 21.0 21.1 ARUP Consult: Ischemic Heart Disease - IHD deprecated reference
- ↑ 22.0 22.1 Bangalore S et al. for the REACH Registry Investigators. beta-blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA 2012 Oct 3; 308:1340. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23032550
- ↑ 23.0 23.1 23.2 Qaseem A et al Diagnosis of Stable Ischemic Heart Disease: Summary of a Clinical Practice Guideline From the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/ Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons. Annals of Internal Medicine, Nov 20, 2012, 10(157) <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23165676 <Internet> http://annals.org/article.aspx?articleid=1392193
Qaseem A et al Management of Stable Ischemic Heart Disease: Summary of a Clinical Practice Guideline From the American College of Physicians/American College of Cardiology Foundation/American Heart Association/American Association for Thoracic Surgery/ Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons Annals of Internal Medicine, Nov 20, 2012, 10(157) <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23165677 <Internet> http://annals.org/article.aspx?articleid=1392195
Fihn SD et al 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. J Am Coll Cardiol Nov 2012 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23182125 <Internet> http://content.onlinejacc.org/article.aspx?articleid=1391404 (corresponding NGC guideline withdrawn Nov 2017)
http://content.nejm.org/cgi/content/short/362/10/886
Fihn SD et al 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart DiseaseA Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;() <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25070666 <Internet> http://content.onlinejacc.org/article.aspx?articleID=1891717 - ↑ 24.0 24.1 Thompson RC Atherosclerosis across 4000 years of human history: the Horus study of four ancienty populations. Lancet. March 10, 2013 http://download.thelancet.com/flatcontentassets/pdfs/S014067361360598X.pdf
- ↑ Pipe AL, Papadakis S, Reid RD. The role of smoking cessation in the prevention of coronary artery disease. Curr Atheroscler Rep. 2010 Mar;12(2):145-50 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20425251
- ↑ Anthony D. Diagnosis and screening of coronary artery disease. Prim Care. 2005 Dec;32(4):931-46. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16326220
- ↑ Patel NB, Balady GJ. Diagnostic and prognostic testing to evaluate coronary artery disease in patients with diabetes mellitus. Rev Endocr Metab Disord. 2010 Mar;11(1):11-20 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20225090
- ↑ 28.0 28.1 Qaseem A et al Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2013;159(11):770-779. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24297193 <Internet> http://annals.org/article.aspx?articleid=1784292
Kansagara D et al Treatment of Anemia in Patients With Heart Disease: A Systematic Review. Ann Intern Med. 2013;159(11):746-757. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24297191 <Internet> http://annals.org/article.aspx?articleid=1784290 - ↑ 29.0 29.1 Mancini GBJ et al Predicting Outcome in the COURAGE TrialCoronary Anatomy Versus Ischemia. J Am Coll Cardiol Intv. 2014;(): <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24440015 <Internet> http://interventions.onlinejacc.org/article.aspx?articleid=1814953
King SB Is It Form or Function?The "Courage" to Ask*. J Am Coll Cardiol Intv. 2014;(): <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24440018 <Internet> http://interventions.onlinejacc.org/article.aspx?articleid=1814954 - ↑ Hotchkiss JW et al. Explaining trends in Scottish coronary heart disease mortality between 2000 and 2010 using IMPACTSEC model: Retrospective analysis using routine data. BMJ 2014 Feb 6; 348:g1088 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24503058 <Internet> http://www.bmj.com/content/348/bmj.g1088
- ↑ 31.0 31.1 Hlatky MA et al. Economic outcomes in the study of myocardial perfusion and coronary anatomy imaging roles in coronary artery disease (SPARC). J Am Coll Cardiol 2014 Mar 18; 63:1002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24636556
Villines TC and Min JK. Comparing outcomes and costs following cardiovascular imaging: A SPARC ... but further illumination is needed. J Am Coll Cardiol 2014 Mar 18; 63:1009. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24412452 - ↑ 32.0 32.1 Selnes OA, Grega MA, Bailey MM, et al. Do management strategies for coronary artery disease influence 6-year cognitive outcomes? Ann Thorac Surg. 2009; 88:445-454 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19632391
- ↑ 33.0 33.1 Herrmann HC FFR-Guided PCI Beats Optimal Medical Therapy for Severe Stable CAD NEJM Journal Watch. Sept 4, 2014 Massachusetts Medical Society (subscription needed) http://www.jwatch.org
De Bruyne B et al. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med 2014 Sep 1 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25176289 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1408758
Rade JJ. FFR-guided PCI - FAME may not be so fleeting after all. N Engl J Med 2014 Sep 1 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25176288 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1410336 - ↑ 34.0 34.1 Maddox TM et al Nonobstructive Coronary Artery Disease and Risk of Myocardial Infarction. JAMA. 2014;312(17):1754-1763. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25369489 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=1920971
- ↑ 35.0 35.1 Hamon M et al. Incidence, source, determinants, and prognostic impact of major bleeding in outpatients with stable coronary artery disease. J Am Coll Cardiol 2014 Oct 7; 64:1430. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25277612
Dauerman HL. Reconsidering the necessity of aspirin in stable coronary artery disease. J Am Coll Cardiol 2014 Oct 7; 64:1437 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25277613 - ↑ 36.0 36.1 36.2 36.3 Rosendorff C et al Treatment of Hypertension in Patients With Coronary Artery Disease. A Scientific Statement From the American Heart Association, American College of Cardiology, and American Society of Hypertension. Hypertension. 2015 Mar 31 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25828847 <Internet> http://hyper.ahajournals.org/content/early/2015/03/30/HYP.0000000000000018
- ↑ Agency for Healthcare Research and Quality (AHRQ) Noninvasive Testing for Coronary Artery Disease. Executive Summary - Mar. 29, 2016 http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productid=2205
- ↑ 38.0 38.1 Pagidipati NJ, Hemal K, Coles A et al. Sex differences in functional stress test versus CT angiography in symptomatic patients with suspected CAD: Insights from PROMISE. J Am Coll Cardiol 2016 Apr 4 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27058908
- ↑ 39.0 39.1 Greenwood JP et al. Prognostic value of cardiovascular magnetic resonance and single-photon emission computed tomography in suspected coronary heart disease: Long-term follow-up of the CE-MARC study. Ann Intern Med 2016 May 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27158921
- ↑ 40.0 40.1 Mark DB et al Economic Outcomes With Anatomical Versus Functional Diagnostic Testing for Coronary Artery Disease. Ann Intern Med. Published online 24 May 2016. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27214597 <Internet> http://annals.org/article.aspx?articleid=2525715
Xie JX, Shaw LJ Measuring Diagnostic Health Care Costs in Stable Coronary Artery Disease: Should We Follow the Money? Ann Intern Med. Published online 24 May 2016. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27214118 <Internet> http://annals.org/article.aspx?articleid=2524808 - ↑ Maron DJ, Boden WE, O'Rourke RA et al Intensive multifactorial intervention for stable coronary artery disease: optimal medical therapy in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial. J Am Coll Cardiol. 2010 Mar 30;55(13):1348-58. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20338496 Free Article
- ↑ 42.0 42.1 Greenwood JP, Ripley DP, Berry C et al. Effect of care guided by cardiovascular magnetic resonance, myocardial perfusion scintigraphy, or NICE guidelines on subsequent unnecessary angiography rates: The CE-MARC 2 randomized clinical trial. JAMA 2016 Aug 29; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27570866
- ↑ 43.0 43.1 CPT :accession 81493
- ↑ 44.0 44.1 Vidal-Petiot E et al. Cardiovascular event rates and mortality according to achieved systolic and diastolic blood pressure in patients with stable coronary artery disease: An international cohort study. Lancet 2016 Aug 30; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27590221
Mancia G. Should blood pressure reduction be aggressive in patient with hypertension and coronary artery disease? Lancet 2016 Aug 30 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27590220 - ↑ 45.0 45.1 Senthong V, Wang Z, Li XS, Fan Y, Wu Y, Tang WH, Hazen SL. Intestinal Microbiota-Generated Metabolite Trimethylamine-N-Oxide and 5-Year Mortality Risk in Stable Coronary Artery Disease: The Contributory Role of Intestinal Microbiota in a COURAGE- Like Patient Cohort. J Am Heart Assoc. 2016 Jun 10;5(6). PMID: https://www.ncbi.nlm.nih.gov/pubmed/27287696 Free PMC Article
- ↑ 46.0 46.1 Shin S et al. Impact of intensive LDL cholesterol lowering on coronary artery atherosclerosis progression: A serial CT angiography study. JACC Cardiovasc Imaging 2016 Oct 19; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27771404
Ahmadi A, Narula J. Primary and secondary prevention, or subclinical and clinical atherosclerosis. JACC Cardiovasc Imaging 2016 Oct 19; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27771400 - ↑ 47.0 47.1 Wiviott SD, Cannon CP, Morrow DA, Ray KK, Pfeffer MA, Braunwald E; PROVE IT-TIMI 22 Investigators. Can low-density lipoprotein be too low? The safety and efficacy of achieving very low low-density lipoprotein with intensive statin therapy: a PROVE IT-TIMI 22 substudy. J Am Coll Cardiol. 2005 Oct 18;46(8):1411-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16226163
- ↑ 48.0 48.1 Hayward RA, Hofer TP, Vijan S. Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Ann Intern Med. 2006 Oct 3;145(7):520-30. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17015870
- ↑ 49.0 49.1 Khera AV, Emdin CA, Drake I et al. Genetic risk, adherence to a healthy lifestyle, and coronary disease. N Engl J Med 2016 Nov 13 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27959714 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1605086
- ↑ 50.0 50.1 Kaplan H, Thompson RC, Trumble BC et al Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study. Lancet. March 17, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28320601 <Internet> http://thelancet.com/journals/lancet/article/PIIS0140-6736(17)30752-3/fulltext
- ↑ 51.0 51.1 Bangalore S, Fayyad R, Laskey R et al. Body-weight fluctuations and outcomes in coronary disease. N Engl J Med 2017 Apr 6; 376:1332 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28379800 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1606148
- ↑ 52.0 52.1 Eikelboom JW, Connolly SJ, Bosch J, et al. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 2017 Aug 27; [e-pub]. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28844192 <Internet> http://www.nejm.org/doi/10.1056/NEJMoa1709118
Braunwald E. An important step for thrombocardiology. N Engl J Med 2017 Aug 27; <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28844176 <Internet> http://www.nejm.org/doi/10.1056/NEJMe1710241
Connolly SJ, Eikelboom JW, Bosch J et al. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: An international, randomised, double- blind, placebo-controlled trial. Lancet 2017 Nov 10; PMID: https://www.ncbi.nlm.nih.gov/pubmed/29132879
Ohman EM. Secondary prevention shifts into second gear. Lancet 2017 Nov 10 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29132878 - ↑ Foy AJ, Dhruva SS, Peterson B et al Coronary Computed Tomography Angiography vs Functional Stress Testing for Patients With Suspected Coronary Artery Disease. A Systematic Review and Meta-analysis. JAMA Intern Med. Published online October 2, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28973101 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655243
Villines TC, Shaw LJ Coronary Computed Tomographic Angiography - The First Test for Evaluating Patients With Chest Pain? JAMA Intern Med. Published online October 2, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28973117 <Internet> http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2655240 - ↑ 54.0 54.1 54.2 54.3 Abbasi J Could a New Method to Detect Coronary Inflammation Prevent Heart Attacks? JAMA. Published online October 4, 2017. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28979995 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2657054
Antonopoulos AS, Sanna F, Sabharwal N et al Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med. 2017 Jul 12;9(398). PMID: https://www.ncbi.nlm.nih.gov/pubmed/28701474 - ↑ 55.0 55.1 Stewart RA, Held C, Hadziosmanovic N et al Physical Activity and Mortality in Patients With Stable Coronary Heart Disease. J Am Coll Cardiol. 2017 Oct 3;70(14):1689-1700 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/28958324 <Internet> http://www.onlinejacc.org/content/70/14/1689
- ↑ NEJM Knowledge+ Question of the Week. Nov 21, 2017 https://knowledgeplus.nejm.org/question-of-week/61/
Task Force Members, Montalescot G, Sechtem U, Achenbach S et al 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J. 2013 Oct;34(38):2949-3003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/23996286 - ↑ 57.0 57.1 Chatterjee NA, Moorthy MV, Pester J et al Sudden Death in Patients With Coronary Heart Disease Without Severe Systolic Dysfunction. JAMA Cardiol. Published online May 2, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29801082 https://jamanetwork.com/journals/jamacardiology/fullarticle/2679908
Tseng ZH Sudden Cardiac Deaths - WHO Says They Are Always Arrhythmic? JAMA Cardiol. Published online May 2, 2018. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29800957 https://jamanetwork.com/journals/jamacardiology/fullarticle/2679906 - ↑ 58.0 58.1 Bangalore S, Fakheri R, Wandel S et al Renin angiotensin system inhibitors for patients with stable coronary artery disease without heart failure: systematic review and meta-analysis of randomized trials. BMJ. 2017 Jan 19;356:j4. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28104622 Free PMC Article
- ↑ 59.0 59.1 Maron DJ, Hochman JS, Reynolds HR et al. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med 2020 Apr 9; 382:1395. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32227755 PMCID: PMC7263833 Free PMC article https://www.nejm.org/doi/10.1056/NEJMoa1915922
Spertus JA, Jones PG, Maron DJ et al. Health-status outcomes with invasive or conservative care in coronary disease. N Engl J Med 2020 Apr 9; 382:1408. PMID: https://www.ncbi.nlm.nih.gov/pubmed/32227753 https://www.nejm.org/doi/10.1056/NEJMoa1916370
Bangalore S, Maron DJ, O'Brien SM et al. Management of coronary disease in patients with advanced kidney disease. N Engl J Med 2020 Mar 30; PMID: https://www.ncbi.nlm.nih.gov/pubmed/32227756 https://www.nejm.org/doi/10.1056/NEJMoa1915925
Spertus JA, Jones PG, Maron DJ et al. Health status after invasive or conservative care in coronary and advanced kidney disease. N Engl J Med 2020 Mar 30; PMID: https://www.ncbi.nlm.nih.gov/pubmed/32227754 https://www.nejm.org/doi/10.1056/NEJMoa1916374 - ↑ 60.0 60.1 Nidorf SM, Fiolet ATL, Mosterd A Colchicine in Patients with Chronic Coronary Disease. N Engl J Med. Aug 31, 2020 PMID: https://www.ncbi.nlm.nih.gov/pubmed/32865380 https://www.nejm.org/doi/full/10.1056/NEJMoa2021372
- ↑ 61.0 61.1 van Rosendael A, van den Hoogen IJ, Gianni U et al Association of Statin Treatment With Progression of Coronary Atherosclerotic Plaque Composition. JAMA Cardiol. Published online August 18, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34406326 https://jamanetwork.com/journals/jamacardiology/fullarticle/2783117
- ↑ 62.0 62.1 Hong SJ, Lee YJ, Lee SJ et al Treat-to-Target or High-Intensity Statin in Patients With Coronary Artery Disease. A Randomized Clinical Trial. JAMA. Published online March 6, 2023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/36877807 https://jamanetwork.com/journals/jama/fullarticle/2802214
- ↑ 63.0 63.1 63.2 63.3 Fuchs A et al. Subclinical coronary atherosclerosis and risk for myocardial infarction in a Danish cohort: A prospective observational cohort study. Ann Intern Med 2023 Mar 28; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36972540 https://www.acpjournals.org/doi/10.7326/M22-3027
McDermott M, Newby DE. Contemporary natural history of coronary artery disease. Ann Intern Med 2023 Mar 28; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36972542 https://www.acpjournals.org/doi/10.7326/M23-0533 - ↑ 64.0 64.1 Hughes S FDA OKs Low-Dose Colchicine for Broad CV Indication. Medscape. June 20, 2023 https://www.medscape.com/viewarticle/993433
- ↑ 65.0 65.1 65.2 65.3 Zito A et al. Diagnostic strategies for the assessment of suspected stable coronary artery disease: A systematic review and meta-analysis. Ann Intern Med 2023 Jun; 176:817. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37276592 https://www.acpjournals.org/doi/10.7326/M23-0231
- ↑ 66.0 66.1 66.2 66.3 66.4 66.5 66.6 66.7 Virani SS, Newby LK, Arnold SV et al 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023. Jul 20. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37471501 Free Article. Review https://www.ahajournals.org/doi/abs/10.1161/CIR.0000000000001168
Rao SV, Reynolds HR, Hochman JS. Chronic Coronary Disease Guidelines Circulation. 2023. Jul 20. PMID: https://www.ncbi.nlm.nih.gov/pubmed/37471475 Free article https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064623 - ↑ 67.0 67.1 Lee SJ, Cha JJ, Choi WG et al Moderate-Intensity Statin With Ezetimibe Combination Therapy vs High-Intensity Statin Monotherapy in Patients at Very High Risk of Atherosclerotic Cardiovascular Disease. A Post Hoc Analysis From the RACING Randomized Clinical Trial. JAMA Cardiol. 2023;8(9):853-858 PMID: https://www.ncbi.nlm.nih.gov/pubmed/37531130 PMCID: PMC10398545 (available on 2024-08-02) https://jamanetwork.com/journals/jamacardiology/fullarticle/2807851
- ↑ National Heart, Lung, and Blood Institute (NHLBI) Coronary Heart Disease https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease