Coronary Artery Disease and Ischaemic Heart Disease Terminology
Definition and Diagnosis
- The European Society of Cardiology recommends using "coronary artery disease" (CAD) to describe atherosclerotic plaque accumulation in the coronary arteries, and "ischaemic heart disease" (IHD) as the broader term encompassing all conditions causing myocardial oxygen supply-demand mismatch, including but not limited to CAD 1
- CAD specifically describes the anatomical pathology of atherosclerotic plaque accumulation in the epicardial coronary arteries that may or may not cause flow limitation 1
- The American Heart Association, as published in Circulation, suggests using the term CAD when discussing angiographic findings of coronary stenosis 2
- The European Heart Journal recommends using the term CAD when discussing plaque burden and atherosclerotic disease progression 1, 3
Clinical Presentation and Evaluation
- The European Heart Journal suggests that patients with angina who may have CAD, microvascular disease, or vasospastic disease should be evaluated for IHD 4
- The American Heart Association, as published in Circulation, recommends risk stratification in patients with suspected IHD 2
- The European Heart Journal states that IHD may result from epicardial CAD, microvascular dysfunction, or coronary vasospasm, and that approximately 40% of patients with angina and suspected IHD do not have obstructive CAD on angiography 4
Diagnostic Testing
- The European Heart Journal recommends using coronary CTA to evaluate CAD, but notes that it is insensitive for detecting coronary microvascular disease (CMD) 6
- The European Heart Journal suggests that functional testing is required to diagnose microvascular ischaemia 3