Prognostic Determinants of Coronary Atherosclerosis in Stable Ischemic Heart Disease

Abstract

Risk stratification in patients with stable ischemic heart disease is essential to guide treatment decisions. In this regard, whether coronary anatomy, physiology, or plaque morphology is the best determinant of prognosis (and driver an effective therapeutic risk reduction) remains one of the greatest ongoing debates in cardiology. In the present report, we review the evidence for each of these characteristics and explore potential algorithms that may enable a practical diagnostic and therapeutic strategy for the management of patients with stable ischemic heart disease.

Maximization of the usage of coronary CTA derived plaque information using a machine learning based algorithm to improve risk stratification; insights from the CONFIRM registry

“…27 However, the prognosis of coronary atherosclerosis is determined by a complex interplay between coronary anatomy, physiology and plaque morphology. 28 Furthermore, specific interactions between CAD and clinical patient profile exist. For instance, Xie et al…”

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“…The alteration in lipid profiles, diabetes and hypertension, are the major risk factors for the development of cardiovascular diseases 44 . Atherosclerosis is the main cause of coronary artery disease identified by a complex process of thickening and narrowing of the arterial walls caused by the accumulation of lipids, primarily oxidized cholesterol, in the intimal or inner layer in combination with connective tissue and calcification creating an atheromatous (fibrofatty) plaque 45 . Atherosclerotic plaque is composed of lipids, cholesterol, oxidized-low density lipoprotein (Ox-LDL), calcium and fibrin that cause hardening and narrowing of the arteries 45 .…”

Is there a role for fractional flow reserve in coronary artery bypass graft (CABG) planning?

“…However, the whole concept of what is a significant lesion, which lesions need revascularization and which are safe with medical therapy is evolving. With ease of access to non-invasive ischemia testing, FFR and plaque morphology assessment (both invasively and non-invasively), decision making regarding revascularization is moving to a much more complete and complex assessment of the lesion as a whole rather than being solely stenosis-based (21).…”