Excerpt

Stable coronary artery disease (CAD) is a major public health burden worldwide and is prevalent in a significant proportion of the adult population. In the USA between 2011 and 2014, around 6.3% of adults over 20 years of age had coronary heart disease (around 20% of adults over 60 years) with a 3.0% prevalence of myocardial infarction and 3.4% prevalence of angina pectoris.1 Globally, ischemic heart disease in present in around 110 million people and in 16.5 million adults with in the USA.1 Patients with obstructive atherosclerotic CAD may be asymptomatic or present with symptoms ranging from stable angina to acute coronary syndromes or sudden cardiac death. The cornerstone treatment of stable CAD is unquestionably the appropriate use of guideline-directed medical therapy to prevent the progression of atherosclerosis, to manage angina symptoms, and to prevent acute coronary syndromes and cardiovascular death.2 Whether revascularizing patients with obstructive but stable CAD would improve cardiovascular outcomes has been an ongoing debate for well over 2 decades now. Furthermore, what is the optimal threshold for differentiating “significant” from “non-significant” CAD and what is the optimal modality for making such a determination remains the most controversial and passionate topic for discussion in current cardiology literature. …