Coronary artery disease (CAD) represents a wide
spectrum of underlying anatomical disease ranging
from near normal, minor single-vessel disease (SVD),
to extensive triple-vessel disease. Its presentation is
similarly variable, from a single episode of chest pain to
acute coronary syndrome (ACS) or even death. The
aim of treatment in CAD is to relieve symptoms and
improve quality of life, reduce cardiovascular (CV)
events, and prolong survival. There have been vast
improvements in management over the years, following
a greater understanding of the underlying pathophysiology,
the identifi cation and appropriate management
of risk factors, development of new medication, and
advances in revascularization techniques, both percutaneous
and surgical. These developments have resulted
in a move towards an anatomic treatment for CAD even
though it is the minor lesion, so-called vulnerable
plaque, which is suggested as the most likely culprit for
mortality. Nevertheless, in those patients presenting
with ACS or ST-elevation myocardial infarction the
long-term benefi ts of percutaneous coronary intervention
(PCI) have been confi rmed in multiple randomized
trials; however, debate surrounds the ideal management
of the majority of patients who have angina, and
who have not experienced any previous CV events or
had an interventional procedure, so-called stable CAD.
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