Diagnosis and Treatment of Patients with Angina

Dear Colleagues,

Myocardial ischemic syndromes remain the leading cause of death worldwide, and angina pectoris is the most common presentation. Most medical attention and resources has been traditionally focused on acute coroanary syndromes, so angina has been perceived as a relatively benign condition with established diagnostic and treatment strategies. However, in recent years a large body of evidence has accumulated that challenges these assumptions, from the close link of angina with coronary atherosclerotic obstructions to the efficacy of treatment strategies based on identification and the removal of the "culprit" lesion.

Guidelines have shifted form a stenocentric approach, to a multifactorial approach, to eventally acknowledging myocardial ischemia as a "syndrome" and no longer as a "disease". This cultural evolution has failed so far to induce consistent changes in the diagnostic and therapeutic approach to angina patients. Despite disturbing signals, such as the ORBITA trial, most cardiologists have considered the "mechanical approach" preferable to the "pharmacological" approach. However, current clinical practice appears difficult to maintain after the presentation of the results of the ISCHEMIA trial.

So, our community is called to carefully reconsider the understanding of myocardial ischemia and of the strategies to diagnose and treat it. This reconsideration will include several steps, such as the following:

• The elusive link between coronary atherosclerotic obstructions and myocardial ischemia;
• Myocardial ischemia from disease to syndrome;
• The prognostic relevance of myocardial ischemia;
• Diagnosing myocardial ischemia;
• The identification of the precipitating mechanism(s) of ischemia;
• The tailored treatment of angina patients;
• Gender aspects of Angina.

Prof. Dr. Mario Marzilli
Guest Editor

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• Angina
• Ischemic syndrome
• Diagnoses
• Medical therapy
• Provocative tests