It seems like it should be unquestionably common sense to treat acute illnesses quickly and slow illnesses slowly. For example, acute myocardial infarction is a classic emergency. The biggest danger in the early stage is arrhythmia, that is, ventricular tachycardia or ventricular fibrillation. At this time, if you can timely extracardiac massage artificial respiration, electric shock defibrillation, not only to save lives and basically no sequelae. Acute myocardial infarction coronary artery acute occlusion, myocardial ischemia, if you can thrombolysis or open the occluded coronary artery in time can save lives, to avoid extensive myocardial necrosis, so the time is myocardium is life, the treatment of these patients is a race against time. Chronic and acute coronary artery disease have significant differences in pathophysiology, treatment and prognosis, and should not be confused. For a long time the diagnosis of coronary heart disease is very arbitrary, diagnosis of acute coronary syndrome abounds, diagnosis and treatment are not according to the priority, most of them belong to the lack of clinical experience. In fact, many belong to the chronic coronary syndrome, also known as chronic coronary heart disease, can be treated slowly, detailed history, improve a variety of tests, mainly non-invasive tests, do not always use coronary angiography and re-vascularization of the treatment.2019 European Cardiology Guidelines appeared in the term chronic coronary syndromes, which includes stable angina pectoris, ischemic cardiomyopathy and insidious coronary artery disease. This new classification can be considered epoch-making in terms of reconceptualizing the pathophysiology of coronary artery disease and guiding its treatment. Chronic ischemia is often accompanied by the process of ischemic preadaptation and the establishment of collateral circulation, and the clinical process and prognosis are completely different from that of acute coronary syndromes. Coronary artery disease is divided into severity and urgency, which is often referred to as the risk stratification of coronary artery disease, which is described in great detail in various guidelines for coronary artery disease. But there are so many guidelines for coronary heart disease that it is difficult to keep track of them. Personal experience over the years has shown that the severity of clinical symptoms and the duration of disease onset remain the best and most accurate stratification. The longer the onset of symptoms, the more stable the disease is, and the shorter the onset of symptoms, the more unstable the disease is. Mild clinical symptoms are considered stable and severe symptoms are considered unstable. The Canadian angina grading remains very practical based primarily on the grading of exertion-induced angina. I envisioned a gray-scale method of risk stratification for coronary artery disease, where previous stratification had clear definitions, but specific application would be neither or both. So I adopted the grayscale method, with a clear large scale and a vague small scale, to allow physicians to decide on their own stratification. I set mild exertional angina of many years as 1 and new onset of severe typical angina (several days) as 10, with a gray area in between for the doctor to decide its severity. Other parameters can be used as weights, such as Canadian angina classification, age, gender, creatinine, troponin, diabetes, hypertension, ejection fraction, electrocardiogram changes, etc. are all risk factors that can be brought into the equation by the doctor himself, not necessarily with great accuracy, as long as there is a trend, and the more risk factors there are, the more unstable the condition is. The more risk factors you have, the more stable your condition will be. I will illustrate the gray scale method of stratification in a specific case below. For example, acute myocardial infarction, with severe chest pain, risk stratification of 10, belonging to high-risk patients, there is no doubt that emergency rescue. However, how to resuscitate should be analyzed on a case-by-case basis. Using the weighting method of analysis, there is no serious co-morbidities, and those who are younger should be revascularized, while those who are older and have co-morbidities such as cerebral infarction, renal insufficiency, anemia, and cancer may need to be treated with medication. Exertional angina that appeared in the last week, typical angina when walking less than a hundred steps, stratification should be around 9,8,7, coronary angiography should be performed to determine the degree of stenosis and to decide on the treatment plan, but there is no need to perform an emergency coronary angiography. Medication centered on antiplatelet agents is also necessary and effective. For example, if the patient had several episodes of classic angina a month ago, but is now angina-free after treatment, the score should be around 7,6,5, which is not an emergency, and a coronary CT can be performed, and then either revascularization or medication can be considered, depending on the condition of the lesion. Patients with a history of anterior myocardial infarction for many years, without typical angina symptoms, and with a risk stratification of about 4,3,2, these patients can undergo coronary angiography, and depending on the results of the angiogram, the next step in the treatment will be decided. It’s the same myocardial infarction but depending on the severity of the symptoms there can be very different treatments. Finally, this patient had a complete occlusion of the anterior descending branch and good collateral circulation in the right coronary artery. According to the gray scale method of stratification, the patient did not have obvious angina stratification should be below 5, and then the weighting method of risk factor analysis, middle-aged men, normal cardiac function, normal renal function, so it is a low-risk chronic occlusion, you can first carry out pharmacological treatment, the patient’s willingness, the anatomical conditions are good can also be done interventional therapy. It can be seen that gray scale stratification mainly depends on clinical symptoms, and the degree of stenosis is not particularly important. In mild angina, or no angina, the risk stratification should be around 1,2,3. In general there is no need for coronary angiography. We often say NoPainNoStent, which also uses the presence or absence of angina to determine the necessity of stenting. In this case, Pain is angina, and the absence of angina is low risk in our stratification. Many clinical studies have shown a strong correlation between symptoms and events, as evidenced by the significantly higher mortality rate of acute yes myocardial infarction, and non-ST-segment elevation myocardial infarction is also a high risk event. In contrast, patients without angina are very unlikely to have an event. Risk factor weights, age, gender, diabetes, cardiac function, renal function, and electrocardiogram are further subdivided, but the main one is stratification by chest pain. There are indeed very few studies in China that stratify risk according to chest pain, and Wu Guijun et al. have the largest number of cases in the country, which is clinically important. This author enrolled 8,156 cases in the chest pain group and 1,672 cases in the no chest pain group, using coronary angiography as a control. The average number of branches of coronary lesions, the ratio of three branches of lesions and the average total score of coronary lesions in the chest pain group were higher than those in the no chest pain group, and the difference was significant, P<0.05, indicating that the diagnosis of coronary arterial lesions according to the stratification of chest pain was more accurate and had more important clinical significance. In this study, according to the symptoms of chest pain is divided into asymptomatic, atypical chest pain, typical angina, previous stent 4 kinds, typical angina than non-angina patients myocardial enzymology increased, ANOVA difference is significant only in the typical angina group, the TNI increased, P<0.05. However, two to two comparisons can be seen atypical chest pain and typical angina appeared to be close to the significant difference between the two, P=0.06, which indicates that the typical angina has the highest diagnostic accuracy. We also did FFR (coronary flow fraction), FFR without chest pain 0.83±.087, atypical chest pain 0.83±.089, typical angina 0.80±.10, and stent 0.80±.096. Although the difference in this study did not reach statistical significance, which may be related to the small number of cases, and has to be verified with larger data, the trend is still clear. Chinese Journal of Cardiovascular Disease The Chinese Journal of Cardiovascular Disease also launched guidelines for the diagnosis and treatment of stable coronary artery disease in 2018. The new version of the guidelines is to open with chest pain, describing in detail the symptomatology of stable coronary heart disease, emphasizing the diagnosis of stable coronary heart disease as a chest pain-centered diagnostic concept, and innovatively proposing the application of probability to assist in the diagnosis of coronary heart disease, the higher the probability of a certain indicator, the higher the accuracy of the diagnosis, for example, typical angina pectoris, advanced age, and males are pointing to the diagnosis of stable coronary heart disease, and in particular emphasizing the nature of chest pain in the differential diagnosis of the Role. The new guidelines categorize chest pain into typical angina, atypical angina, and chest pain of a non-anginal nature. Typical angina, or exertion-related chest pain, is diagnosed with a high degree of accuracy. No angina, atypical angina and chest pain of a non-anginal nature, especially in patients with no angina, are diagnosed on the basis of imaging and treatment decisions based on imaging are made with great caution. Clinically, there are quite a few cases of atypical angina and non-anginal chest pain that end up leading to coronary intervention, and this kind of situation is laughable. The point is that stent implantation in such cases has many consequences. Not to mention surgical complications, subsequent restenosis leading to endless interventions is a serious problem. Although the clinical diagnosis is very important, the final diagnosis still depends on imaging, because the degree of stenosis on coronary CT and coronary angiography is too closely correlated with prognosis to be replaced by any other indicator. As a result, despite the fact that the guidelines talk a lot about ischemia testing, the real-world use of it remains low. Despite the strong correlation between the degree of coronary CT or angiographic stenosis and prognosis, stable revascularization has not been proven to reduce mortality, although other endpoints such as angina, recurrent hospitalization rates, and extent of myocardial ischemia may be valid, and therefore guideline-guided pharmacotherapy has gained more and more importance in recent years. This is the nopainnostent that I have advocated in the past, that patients without angina symptoms should avoid revascularization therapy as much as possible. Patients with mild to moderate angina should be treated first with intensive pharmacologic therapy, and recanalization should be considered only if pharmacologic therapy is not effective; severe angina is not really stable coronary artery disease anymore. A recent study randomized patients with stable angina who had significant stenosis into a stent group and a drug group in a double-blind fashion, where the patients only knew that they had had an angiogram, but whether or not they had a stent put in was unknown to the patient. The results showed no difference in similar event rates in the 2 groups. This suggests that in stable coronary artery disease, medications may have similar effects as stents. Stable coronary artery disease is a slow disease, and the diagnostic strategy should also be step-by-step and gradual; there is no need for emergency admission to the hospital, coronary angiography immediately after admission, and stenting immediately after angiography. Non-invasive tests such as exercise test, myocardial nuclear, echocardiography, etc. can be arranged before the operation, and the examination can be as exhaustive as possible, and if there is no myocardial ischemia, coronary angiography can be postponed. Even if there is myocardial ischemia there is no need for immediate coronary angiography, so why can't we follow the guidelines for intensive drug therapy? The medication should also be allowed to continue for a period of time to observe the effects. Even with coronary angiography there is no need to put in a stent right away, especially if the stenosis is not very severe or if it is not a critical stenosis, such as the left main stem. In short, treat slow disease slowly, watch and treat, and there is no rush to do revascularization right away.