RT Book, Section
A1 Bangalore, Sripal
A1 Ali, Ziad
A1 Narula, Jagat
A1 Puskas, John
A1 Stone,  Gregg W.
A2 Fuster, Valentin
A2 Narula, Jagat
A2 Vaishnava, Prashant
A2 Leon, Martin B.
A2 Callans, David J.
A2 Rumsfeld, John
A2 Poppas, Athena
SR Print(0)
ID 1191371958
T1 Chronic Coronary Syndromes
T2 Fuster and Hurst's The Heart, 15e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781264257560
LK accesscardiology.mhmedical.com/content.aspx?aid=1191371958
RD 2023/02/07
AB Chapter  SummaryThis  chapter  reviews  the  epidemiology,  diagnosis,  and  management  of  chronic  coronary  syndromes  (see  Fuster  &  Hurst’s  Central  Illustration).  Assessment  of  pretest  probability  of  coronary  artery  disease  (CAD)  aids  in  appropriate  risk  stratification  of  patients  with  suspected  chronic  coronary  syndromes.  The  Duke,  updated  Diamond–Forrester,  and  CORSCORE  risk  models  are  the  most  accurate  in  predicting  CAD.  The  ischemic  cascade  is  based  on  progressive  mismatch  between  coronary  blood  flow  and  myocardial  oxygen  demand  and,  since  perfusion  defects  occur  earlier  than  do  wall  motion  abnormalities,  tests  that  rely  on  detection  of  perfusion  defects  (such  as  SPECT)  are  more  sensitive  than  those  that  detect  wall  motion  abnormalities  (such  as  stress  echocardiography),  which  are  more  specific  for  the  detection  of  obstructive  CAD.  Detection  of  CAD  by  coronary  computed  tomography  angiography  is  associated  with  a  reduced  incidence  of  myocardial  infarction.  Goal-directed  medical  therapy  consists  of  intensive  and  comprehensive  secondary  prevention  and  includes  lifestyle  and  pharmacological  approaches.  Patients  with  refractory  symptoms  despite  goal-directed  medical  therapy,  and/or  elevated  clinical  or  angiographic  risk  profiles  and  suitable  coronary  anatomy,  may  benefit  from  revascularization.  Coronary  artery  anatomy,  left  ventricular  systolic  function,  systemic  factors  (eg,  diabetes),  and  patient  values  and  preferences  should  be  considered  when  choosing  the  revascularization  strategy  (ie,  percutaneous  coronary  intervention  versus  coronary  artery  bypass  graft  surgery).