Author + information
- Received June 16, 2016
- Revision received August 17, 2016
- Accepted August 24, 2016
- Published online December 6, 2016.
- aDepartment of Medicine/Cardiology Division, Johns Hopkins University, Baltimore, Maryland
- bMount Sinai Medical Center, Icahn School of Medicine at Mount Sinai Medical Center, New York, New York
- cCentro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- ↵∗Reprint requests and correspondence:
Dr. Armin Arbab-Zadeh, Division of Cardiology, Johns Hopkins University, 600 North Wolfe Street, Halsted 559, Baltimore, Maryland 21287-0025.
Patients undergoing coronary angiography for suspected coronary heart disease who are found to have coronary atherosclerotic disease with <50% diameter stenosis may carry a risk of adverse cardiac events similar to that in patients with single-vessel obstructive disease. Yet clinical practice guidelines offer no direction for managing symptomatic patients with nonobstructive coronary atherosclerosis because current diagnostic criteria for coronary heart disease are not met. Accordingly, secondary preventive measures are not endorsed, and their role is not defined in this setting. Available data suggest that we are missing the opportunity to provide effective preventive measures in millions of patients with nonobstructive coronary heart disease. The emergence of noninvasive coronary angiography in patients with suspected coronary heart disease provides the opportunity to transition from a categorical perspective on the presence or absence of coronary heart disease to accepting the risk continuum from atherosclerosis and its implications for diagnosis and management.
Both authors have reported that they have no relationships relevant to the contents of this paper to disclose. Robert Vogel, MD, served as Guest Editor for this paper.
- Received June 16, 2016.
- Revision received August 17, 2016.
- Accepted August 24, 2016.
- American College of Cardiology Foundation
- Central Illustration
- Defining the Issue
- Scope of the Problem
- Historical Perspective
- Obstructive Versus Hemodynamically Significant CHD
- Controversies Over the Nomenclature and Anatomic Threshold Defining CHD
- Stenosis Assessment Versus Atherosclerotic Burden Evaluation
- Expanding the Criteria for CHD by Angiography
- Risk Modifiers
- Implications for Management