Myocardial ischemia: From disease to syndrome. (1st September 2020) - Marzilli, Mario
Abstract: Although current guidelines on the management of stable coronary artery disease acknowledge that multiple mechanisms may precipitate myocardial ischemia, recommended diagnostic, prognostic and therapeutic algorithms are still focused on obstructive epicardial atherosclerotic lesions, and little progress has been made in identifying management strategies for non-atherosclerotic causes of myocardial ischemia. The purpose of this consensus paper is three-fold: 1) to marshal scientific evidence that obstructive atherosclerosis can co-exist with other mechanisms of ischemic heart disease (IHD); 2) to explore how the awareness of multiple precipitating mechanisms could impact on pre-test probability, provocative test results and treatment strategies; and 3) to stimulate a more comprehensive approach to chronic myocardial ischemic syndromes, consistent with the new understanding of this condition. Highlights: Myocardial ischemia: form atherosclerotic obstructions to a multifactorial condition Identifying the mechanism responsible for myocardial ischemia Rationale use of provocative tests in diagnosing myocardial ischemia Revascularization and medical therapy for chronic coronary syndromes