Asymptomatic multivessel coronary artery disease: Diagnostic and therapeutic approach

Coronary artery disease (CAD) remains a leading cause of cardiovascular morbidity and mortality worldwide. Despite the fact that significant portion of patients remain asymptomatic, the absence of anginal symptoms does not exclude advanced disease, especially in patients with diabetes mellitus. Such patients often suffer from silent ischemia and unrecognized myocardial infarction. Consequently, early identification of high-risk asymptomatic individuals represents a major clinical challenge, as delayed recognition may lead to preventable adverse cardiovascular outcomes. We present the case of a 76-year-old male with multiple cardiovascular risk factors and asymptomatic multivessel CAD, who was diagnosed through a structured, risk-based diagnostic evaluation. Through this case, we illustrate the clinical pathway from initial presentation to advanced imaging and invasive assessment, emphasizing the importance of a proactive diagnostic strategy integrating anatomical and functional evaluation in high-risk asymptomatic patients.