E. Navarese et al. (Nicolaus Copernicus University, Poland) presented the results of a new meta-analysis of revascularisation plus medical therapy versus medical therapy alone in patients with chronic coronary syndromes. A total of 19,806 patients with chronic coronary syndromes undergoing elective revascularisation from 25 randomised trials were pooled.

This article by Q. Radaideh et a. (Midwest Cardiovascular Research Foundation, USA) reviews the evidence on optimal medical therapy versus coronary revascularization in patients with stable ischaemic heart disease. The recently published ISCHEMIA trial has established the non-inferiority of medical therapy in comparison to coronary revascularisation in patients with moderate to severe ischaemia.

Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anaemia, polypharmacy and both increased bleeding/thrombotic risk.
In geriatric populations, acute coronary syndromes are associated with an increased frailty degree. Frail elderly patients are increasingly referred to cardiac rehabilitation programs after acute coronary syndromes.

Despite the increasing use, better logistics and improved methodology of interventional approaches for coronary reperfusion, the mortality and morbidity from acute myocardial infarction are still substantial. This is very clear when examining the real world data. This issue is complex: patients with acute myocardial infarction are typically advanced in age, have comorbidities and are receiving several medications. For them, it is necessary to consider not only infarct size reduction but also attenuation of coronary microvascular obstruction, as well as longer-term targets including infarct repair and reverse remodelling.

In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients.

T. J. Ford et al. (British Heart Foundation, UK) performed a multimodality investigation into the role of ET-1 and this gene variant in the pathogenesis of coronary microvascular dysfunction in 391 patients with symptoms and/or signs of ischaemia but no obstructive coronary artery disease.

This review by U. Sechtem et al. (Robert Bosch Krankenhaus, Stuttgart, Germany) focuses on the challenges of identifying the presence of CMD in the context of diffuse non-obstructive CAD and obstructive CAD.

A significant percentage of patients suffer ischaemic events in the absence of epicardial coronary artery obstruction. Coronary microvascular dysfunction (CMD) refers to a term covering a wide spectrum of clinical situations in which the structure and function of the coronary microcirculation is affected

Prof Magdy Abdelhamid, Cairo, Egypt, explains why the Angina Updates initiative is so relevant for clinicians and patients in Egypt. Angina and Coronary Artery Disease are very prevalent in connection with the obesity pandemic, and the discussion around risks assessments and symptoms management is critical.

Prof Rosano will lead an educational project to improve knowledge and skills in the field of vascular ultrasound. Create an account on Angina Updates to receive more information.