Coronary Artery Disease (CAD)

Summary

Coronary artery disease (CAD) is the leading cause of death in the United States. As plaque accumulates in the coronary arteries, blood flow to the heart decreases. The location of these blockages, the specific coronary arteries affected, and the number of lesions all influence the timing and severity of blood flow restriction. A rapidly occurring occlusion in the proximal left main coronary artery can lead to sudden death if not promptly treated. In contrast, a slowly progressing, diffuse lesion in a distal segment of the right coronary artery may remain asymptomatic and never cause significant effects.

Classic symptoms such as chest pain, shortness of breath, and diaphoresis often prompt patients to seek medical attention. The initial evaluation includes troponin testing and an EKG, while the definitive diagnosis is made through coronary angiography. Treatment is guided by findings from cardiac catheterization.

Key Terms

Atherosclerosis
mostly substances of cholesterol, fatty acids, cellular waste products, calcium and fibrin builds up inside of arteries as plaque. The arterial wall becomes thick and hard because of the plaques. The process and result is atherosclerosis.
Plaque
buildup of cholesterol, fatty substances, cellular waste products, calcium and fibrin in the arteries
Lesion
in the context of CAD, refers to a spot within the coronary artery that is constricted due to plaque buildup
GDMT
goal directed medical therapy.
Angina
CCD
Chronic Coronary Artery Disease

Epidemiology

Etiology

Pathophysiology

History of Present Illness

Physical Examination

Diagnostics

Treatment

Treatment Comparrison PCI vs. CABG

PCI CABG
Primary Indications
  • Single or dual-vessel disease.
  • STEMI
  • Unstable angina or NSTEMI w/ suitable anatomy.
  • Multi-vessel disease, especially with diabetes or ↓ LV funx.
  • Left main coronary artery disease.
  • Complex coronary anatomy (e.g., SYNTAX score >22).
Procedure Minimally invasive, performed via catheterization. Invasive, requiring open-heart surgery and grafting.
Recovery Time Faster recovery (1-2 days in the hospital). Longer recovery (5-7 days in the hospital; weeks at home).
Durability
  • Effective for 5-10 years depending on stent type and patient adherence.
  • Higher likelihood of requiring repeat interventions.
  • Grafts typically last 10-15 years or longer.
  • Lower risk of repeat interventions compared to PCI.
Risks
  • Bleeding or hematoma at the catheter site.
  • Stent thrombosis or restenosis.
  • Allergic reaction to contrast dye.
  • Increased risk of stroke compared to PCI.
  • Infection, bleeding, or graft failure.
  • Higher initial procedural risk.
Outcomes
  • Good outcomes for single-vessel disease.
  • Lower long-term survival rates in complex disease compared to CABG.
  • Superior survival rates in multi-vessel disease and diabetic patients.
  • Better long-term outcomes for complex cases.

Knowledge Check

Upon workup for coronary artery disease, which pt's should receive stress test vs. coronary angiography?

References