Until recently, coronary revascularization with coronary artery bypass grafting or percutaneous coronary intervention has been regarded as the standard choice for stable coronary artery disease (CAD), particularly for patients with a significant burden of ischemia. However, in conjunction with remarkable advances in adjunctive medical therapy and a deeper understanding of its long-term prognosis from recent large-scale clinical trials, including ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches), the approach to stable CAD has changed drastically. Although the updated evidence from recent randomized clinical trials will likely modify the recommendations for future clinical practice guidelines, there are still unresolved and unmet issues in Asia, where prevalence and practice patterns are markedly different from those in Western countries. Herein, the authors discuss perspectives on: 1) assessing the diagnostic probability of patients with stable CAD; 2) application of noninvasive imaging tests; 3) initiation and titration of medical therapy; and 4) evolution of revascularization procedures in the modern era.
Keywords: CABG, coronary artery bypass grafting; CAD, coronary artery disease; CTA, computed tomographic angiography; DAPT, dual antiplatelet therapy; EF, ejection fraction; FFR, fractional flow reserve; ICA, invasive coronary angiography; IVUS, intravascular ultrasound; LVEF, left ventricular ejection fraction; OCT, optical coherent tomography; OMT, optimal medical therapy; PCI, percutaneous coronary intervention; PTP, pretest probability; RCT, randomized clinical trial; noninvasive testing; optimal medical therapy; pretest probability; revascularization; stable coronary artery disease.
© 2023 The Authors.