Guidelines for the diagnosis and treatment of coronary artery disease

  Coronary atherosclerotic heart disease is a heart disease caused by atherosclerotic lesions in the coronary arteries that narrow or block the lumen of the vessels, resulting in ischemia, hypoxia or necrosis of the myocardium, and is often referred to as “coronary heart disease. However, the scope of coronary artery disease may be broader, including inflammation, embolism, etc., resulting in narrowing or occlusion of the lumen. The World Health Organization classifies coronary artery disease into five major categories: asymptomatic myocardial ischemia (occult coronary artery disease), angina pectoris, myocardial infarction, ischemic heart failure (ischemic heart disease), and sudden death. In clinical practice, they are often divided into stable coronary artery disease and acute coronary syndromes.  The diagnosis of coronary artery disease relies primarily on typical clinical symptoms combined with ancillary tests to detect evidence of myocardial ischemia or coronary artery obstruction and markers of myocardial injury to determine the presence of myocardial necrosis. The most commonly used tests to detect myocardial ischemia include conventional electrocardiogram and electrocardiographic stress test, and nuclear myocardial imaging. Invasive tests include coronary angiography and intravascular ultrasound. However, a normal coronary angiogram does not completely negate coronary artery disease. Usually, non-invasive and convenient auxiliary examinations are performed first.  Treatment of coronary artery disease 1.Lifestyle change: quit smoking and limit alcohol, low-fat and low-salt diet, appropriate physical exercise, weight control, etc.; 2.Medication: anti-thrombotic (anti-platelet, anticoagulation), reduce myocardial oxygen consumption (β-blockers), relieve angina (nitrates), lipid regulation and stabilization of plaque (statin lipid regulators); 3.Hemodynamic reconstruction treatment: including interventional treatment (intravascular balloon dilation and angioplasty and stent implantation) and surgical coronary artery bypass grafting. Drug therapy is the basis of all treatment. Interventional and surgical procedures are also followed by long-term standard drug therapy. For the same patient, medications are ideally controlled at one stage of the disease, while at another stage medications alone are often not effective and need to be combined with interventional or surgical procedures.