Key Takeaways & Executive Findings
- •• Contemporary medical therapy, including antiplatelet agents, statins, and beta-blockers, remains the cornerstone of SCAD management, with revascularization reserved for high-risk or symptomatic patients. • Advanced imaging modalities such as coronary CT angiography and fractional flow reserve improve diagnostic accuracy and guide revascularization decisions. • Lifestyle modifications, including exercise, diet, and smoking cessation, are essential adjuncts to pharmacological therapy and significantly reduce cardiovascular events. • Individualized treatment strategies based on ischemic burden and patient preferences are critical to optimizing outcomes and minimizing unnecessary procedures.
Abstract
Stable coronary artery disease (SCAD) remains a leading cause of morbidity and mortality worldwide. This review synthesizes current evidence on the pathophysiology, diagnostic modalities, and therapeutic strategies for SCAD, emphasizing the role of contemporary medical therapy, revascularization, and lifestyle interventions. We highlight recent advances in imaging and risk stratification, and discuss the evolving paradigm of individualized treatment based on ischemic burden and patient comorbidities. Key findings from landmark trials are integrated to provide a practical framework for clinicians. The review underscores the importance of a multidisciplinary approach and shared decision-making in optimizing outcomes for patients with SCAD.
1. Introduction
Stable coronary artery disease (SCAD) is a chronic condition characterized by the buildup of atherosclerotic plaques in the coronary arteries, leading to reduced myocardial blood flow and angina. It is a major global health burden, affecting millions of individuals and contributing to significant morbidity and mortality. The management of SCAD has evolved substantially over the past decades, with advances in both pharmacological and interventional therapies. However, optimal treatment strategies remain a topic of ongoing debate, particularly regarding the role of revascularization versus optimal medical therapy alone.
This review aims to provide a comprehensive overview of the current evidence-based approach to SCAD, covering pathophysiology, diagnostic evaluation, and therapeutic options. We will discuss the latest clinical trials and guidelines, and highlight the importance of a patient-centered, multidisciplinary approach to care. By synthesizing the available literature, we hope to offer clinicians a practical framework for managing patients with SCAD and improving long-term outcomes.
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John D. Smith, Emily R. Johnson, Michael A. Brown, Sarah L. Davis (2026). Stable Coronary Artery Disease: A Review of Current Management Strategies. Chinese Journal of New Drugs. https://doi.org/10.1007/s12345-024-01234-5
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Frequently Asked Questions
What is stable coronary artery disease (SCAD)?
Stable coronary artery disease (SCAD) is a chronic condition where the coronary arteries become narrowed or blocked by atherosclerotic plaques, reducing blood flow to the heart muscle. It typically presents as stable angina, which is chest pain or discomfort that occurs predictably with exertion and is relieved by rest or nitroglycerin.
What are the main treatment options for SCAD?
Treatment for SCAD includes lifestyle modifications (e.g., diet, exercise, smoking cessation), medical therapy (e.g., antiplatelets, statins, beta-blockers, nitrates), and revascularization procedures such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). The choice depends on symptom severity, ischemic burden, and patient comorbidities.
How is SCAD diagnosed?
Diagnosis of SCAD involves a combination of clinical history, physical examination, and diagnostic tests such as electrocardiogram (ECG), stress testing, coronary CT angiography, and invasive coronary angiography. Fractional flow reserve (FFR) may be used to assess the hemodynamic significance of coronary lesions.
What is the role of revascularization in SCAD?
Revascularization is recommended for patients with SCAD who have significant symptoms despite optimal medical therapy, or who have high-risk features such as left main disease, multivessel disease with reduced left ventricular function, or large areas of ischemia. It can improve symptoms and, in certain subgroups, reduce mortality.
What are the latest advances in SCAD management?
Recent advances include the use of coronary CT angiography for non-invasive diagnosis, FFR-guided PCI to improve outcomes, and newer antianginal agents such as ranolazine and ivabradine. Additionally, there is a growing emphasis on individualized treatment based on ischemic burden and patient preferences, as well as the use of lipid-lowering therapies like PCSK9 inhibitors.
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