Coronary microvascular dysfunction (CMD) is the main mechanism underlying microvascular angina (MVA), i.e. myocardial ischemia without significant flow-limiting obstructive coronary artery disease (CAD). Invasive methods, such as reactivity testing using acetylcholine or adenosine during coronary angiography, are the current gold standard for CMD diagnosis in the absence of myocardial diseases.

As pointed by J. Gavara et al. (Universitat Politècnica de València, Valencia, Spain), the role of revascularisation in chronic coronary syndrome and the value of ischaemia vs. anatomy to guide decision-making are in constant debate.
For this reason, they explored the potential of “a combined assessment of ischaemic burden by vasodilator stress cardiovascular magnetic resonance and presence of multivessel disease by angiography to predict the effect of revascularisation on all-cause mortality in chronic coronary syndrome”.

Presentations with suspected stable angina are common yet determining an accurate diagnosis is frequently challenging. It is in this context that a role has emerged for the most recent generation of high-sensitivity cardiac troponin assays. High-sensitivity troponin (hsTn) has demonstrated prognostic value in stable outpatients with symptoms suggestive of coronary artery disease (CAD). A. Sharma et al. (McGill University, Montreal, Quebec, Canada) measured single molecule counting high-sensitivity troponin I in symptomatic outpatients in the PROMISE ((Prospective Multicenter Imaging Study for Evaluation of Chest Pain) study. The goal was to evaluate the hypothesis that hsTnI may identify patients who are unlikely to have inducible ischaemia on stress imaging or events and for which therefore testing is unlikely to be beneficial.

Coronary artery disease (CAD) can cause angina, myocardial infarction, sudden death and heart failure. Its treatments include optimal medical therapy (OMT), surgical revascularization and percutaneous coronary intervention (PCI) revascularization.
This review by Santucci and Cavallini dissects the results of two studies, COURAGE (2007) and ISCHEMIA (2020), which compared an invasive strategy (selective coronary angiography and PCI revascularization) to a non-invasive one (OMT alone) in patients with myocardial ischemia due to CAD.

Optimal treatment strategy for managing stable ischemic heart disease is still a topic of debate. The purpose of this review by P. Vafaei et al. (Kaiser Permanente San Francisco Medical Center, California USA) is to discuss treatment strategies for managing stable coronary artery disease. It reviews findings based on the COURAGE trial (2007) and ISCHEMIA trial (2020).
For the authors, when applied to a broad population with stable CAD, evidence suggests there is no benefit to an initial invasive revascularisation strategy relative to optimal medical therapy alone.

Optimal treatment strategy for managing stable ischemic heart disease is still a topic of debate. The purpose of this review by P. Vafaei et al. (Kaiser Permanente San Francisco Medical Center, California USA) is to discuss treatment strategies for managing stable coronary artery disease. It reviews findings based on the COURAGE trial (2007) and ISCHEMIA trial (2020.
For the authors, when applied to a broad population with stable CAD, evidence suggests there is no benefit to an initial invasive revascularisation strategy relative to optimal medical therapy alone.

There is very little data comparing plaque characteristics and wire-free physiological assessment in the target vessel in patients with stable angina versus acute coronary syndrome.

In this study, K. Dan et al. (USA)investigated the difference in plaque distribution between stable angina and NSTEMI, and explored the relationship between target vessel vulnerability by optical coherence tomography and wire-free functional assessment with quantitative flow ratio.

Dyslipidemia is known to be significantly associated with an increased risk of CAD and lipid-lowering strategy is the key approach for primary and secondary prevention.
In this cohort study, D. Kanda et al. (Kagoshima University, Japan) aimed to examine the clinical meaning of LDL-C ＜70 mg/dL and non-HDL-C ＜100 mg/dL on the occurrence of new lesions among Japanese patients with stable angina who were prescribed with strong statins.

Elevation of blood urea nitrogen (BUN) indicates renal dysfunction and is associated with increased mortality in cardiovascular diseases.
The authors investigated the relationship between the blood urea nitrogen concentration measured at hospital admission and the long-term all-cause mortality in 344 patients with stable angina pectoris, during a mean follow-up period of 8 yrs.

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.