Subacute coronary artery occlusion: complexities of the grey zone

Abstract The clinical manifestations and management of obstructive epicardial coronary artery disease vary across acute (acute coronary syndromes) and chronic (chronic coronary syndromes) settings, each with distinct benefits and risks. Most acute occlusions require emergent revascularization to prevent myocardial damage and reduce the risk for major adverse cardiovascular events. Conversely, most symptomatic chronic occlusions are treated with guideline-directed medical therapy while revascularization is reserved to provide symptom relief in those with refractory symptoms despite medical therapy. Subacute coronary occlusions (SCOs), a group that historically has not been well defined, are positioned in the grey zone between these extremes, yet pose significant clinical challenges and require case-by-case assessment. This review explores the nuances of managing SCOs, highlighting the importance of tailored strategies for each clinical context.