Myocardial ischemia as a multifactorial: Disease: What is new?

Strategies for ischemic heart disease (IHD) focus almost exclusively on coronary atherosclerosis because access to interventional procedures is easy and gives gratifying angiographic results. This assumes that coronary artery disease and IHD are functionally identical. Recent reports, however, challenge the "plaque-centric" hypothesis of IHD. Alternative mechanisms, including coronary microvascular dysfunction, endothelial dysfunction, platelet dysfunction, coronary vasospasm, and inflammation, can precipitate myocardial ischemia (MI) in man. So, to assume that stenosis removal is a consistent cure for IHD is unwise, as is discounting MI because an angiogram appears "normal" after percutaneous coronary intervention or assuming MI is present because an atherosclerotic plaque is visible on angiography. © 2011 LLS SAS. All rights reserved