Why the study?
Current algorithms for stable coronary artery disease focus on obstructive epicardial atherosclerotic lesions, with little progress made in identifying management strategies for non-atherosclerotic causes of myocardial ischemia.
This consensus paper highlights the need to recognize and manage non-atherosclerotic causes of myocardial ischemia, challenging the traditional exclusive focus on obstructive epicardial disease.
Clinicians may need to weigh coexisting mechanisms when interpreting tests; leaves open outcome trials of non-atherosclerotic ischemia therapies.
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.
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Marzilli et al. (2020) studied this question.
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