Right Patient to Revascularize in Chronic Coronary Syndrome

Abstract

​Concept of chronic coronary syndrome (CCS) is changing from epicardial obstructive lesion causing ischemia to a systemic pathophysiologic disorder involving the whole coronary vasculature including dysfunction in microvasculature.Non-invasive imaging is now more often used for diagnosisthan invasive angiography and functional significance of obstructive lesions is now more often determined.Landmark trials have established the role of optimal medical therapy (OMT) as the mainstay of treatment in CCS to decrease symptom, improve survival and overall quality of life. Revascularisation plays an important role in the management of select patients with CCS, particularly those with refractory angina despite optimal medical therapy, left main coronary disease, three vessel disease, left ventricular systolic dysfunction and diabetes. While percutaneous coronary intervention (PCI) provides a less invasive option, coronary artery bypass grafting (CABG) remains the preferred strategy for extensive coronary disease, particularly in high-risk populations. The choice between PCI and CABG depends on various factors, including anatomical complexity of coronary lesions, eligibility for surgery and individual preference. Determination of physiological significance of anatomical obstructive lesions by both invasive and non-invasive methods are increasingly used for management decision.Shared decision-making between the patient and their healthcare team is crucial to ensure that revascularisation is used appropriately and effectively.