The myth of ‘stable’ coronary artery disease

Abstract

Patients with known cardiovascular (CV) disease who have not suffered a recent acute event are often referred to as having 'stable coronary artery disease (CAD)'. The concept of 'stable' CAD is misleading for two key reasons: the continuing risks of CV events over the longer term, and the diverse but powerful spectrum of risk characteristics. The risks of CV events are frequently underestimated and occur despite current standards of care for secondary prevention, including lifestyle changes, optimal medical therapy, myocardial revascularization, and use of antiplatelet agents to limit thrombosis. In dispelling the myth of 'stable' CAD, we explore the pathophysiology of the disease and the relative contribution of plaque and systemic factors to CV events. A broader concept of the vulnerable patient, not just the 'vulnerable' plaque, takes into account the diversity and future risks of atherothrombotic events. We also evaluate new and ongoing research into medical therapies aimed at further reducing the risks of CV events in patients with chronic but not 'stable' atherothrombotic disease.

Cost-Effectiveness of Coronary and Peripheral Artery Disease Antithrombotic Treatments in Finland

“…We considered the debate regarding the stable CAD term [31] and applied the CCS concept according to the ESC guidelines [30]. In comparison to the earlier stable CAD terminology, CCS describes the different clinical presentations of the disease and is coherent with acute coronary syndrome [30].…”

“…Since the clinical presentations of CAD can be categorized as either acute coronary syndrome or CCS, stable CAD was replaced by CCS in the ESC guidelines [30]. For simplicity, CCS is used in this study to reflect the stable CAD [30] (i.e., chronic CAD [31]) population. Full health economic evaluation of CCS or symptomatic PAD in Finland has not been published.…”

Chronisches Koronarsyndrom

“…Der progrediente Verlauf der Erkrankung, gekennzeichnet durch Akkumulierung von atherosklerotischen Plaques, führt jedoch häufig zu rezidivierenden kardiovaskulären Ereignissen. Aus diesem Grund wurde der Begriff "stabile KHK" immer wieder infrage gestellt [1]. In der neuen ESC-Leitlinie wurde nun der neue Terminus "chronisches Koronarsyndrom (CCS)" eingeführt [2].…”

A Novel and Simply Calculated Cardiac Load Index Correlates With Coronary Artery Disease

“…Myocardial oxygen consumption depends on the wall tension, heart rate, myocardial contractility, and ejection time [6]. Systolic blood pressure (SBP) multiplied by heart rate (HR) is linearly related to myocardial oxygen consumption, and is an indicator of the cardiac workload [7].…”