Prognostic Determinants of Coronary Atherosclerosis in Stable Ischemic Heart Disease: Anatomy, Physiology, or Morphology?

Amir Ahmadi; Gregg W Stone; Jonathon Leipsic; Leslee J Shaw; Todd C Villines; Morton J Kern; Harvey Hecht; David Erlinge; Ori Ben-Yehuda; Akiko Maehara; Eloisa Arbustini; Patrick Serruys; Hector M Garcia-Garcia; Jagat Narula

doi:10.1161/CIRCRESAHA.116.308952

Prognostic Determinants of Coronary Atherosclerosis in Stable Ischemic Heart Disease: Anatomy, Physiology, or Morphology?

Circ Res. 2016 Jul 8;119(2):317-29. doi: 10.1161/CIRCRESAHA.116.308952.

Affiliations

¹ From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of California San Diego (O.B.-Y.); Policlinico San Matteo Pavia Fondazione, Pravia, Italy (E.A.); Imperial College, London, United Kingdom (P.S.); and Leesburg Regional Medical Centre, FL (H.M.G.-G.).
² From the Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY (A.A., H.H., J.N.); Columbia University Medical Center, Cardiovascular Research Foundation, New York, NY (G.W.S., A.M.); University of British Columbia, Vancouver, British Columbia, Canada (A.A., J.L.); Emory University School of Medicine, Atlanta, GA (L.J.S.); Walter Reed National Military Medical Center, Bethesda, MD (T.C.V.); University of California Irvine (M.J.K.); Lund University, Sweden (D.E.); University of California San Diego (O.B.-Y.); Policlinico San Matteo Pavia Fondazione, Pravia, Italy (E.A.); Imperial College, London, United Kingdom (P.S.); and Leesburg Regional Medical Centre, FL (H.M.G.-G.). jagat.narula@mountsinai.org.

PMID: 27390334
DOI: 10.1161/CIRCRESAHA.116.308952

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.

Keywords: coronary artery disease; fractional flow reserve; multidetector computed tomography; myocardial ischemia; plaque, atherosclerotic.

Publication types

Review

MeSH terms

Coronary Angiography* / methods
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / epidemiology
Coronary Artery Disease / pathology
Coronary Vessels / anatomy & histology
Coronary Vessels / diagnostic imaging*
Coronary Vessels / physiology
Humans
Myocardial Ischemia / diagnostic imaging*
Myocardial Ischemia / epidemiology
Myocardial Ischemia / pathology
Plaque, Atherosclerotic / diagnostic imaging
Plaque, Atherosclerotic / epidemiology
Plaque, Atherosclerotic / pathology
Prognosis
Risk Assessment