As we continue to move along this progression from coronary artery disease defined by anatomy to SIHD defined by anatomy, functionality, microvascular and cellular processes, our thinking about therapy and intervention will continue to evolve as well. This has and will continue to create new opportunities for understanding physiology and pathophysiology, transforming existing therapies and creating the knowledge base for the development of entirely new prevention and treatment therapies. Importantly, it will likely guide further technology developments in CVD revascularization. Incremental technology developments with presumed improvement for patients will be replaced by significant technology advances linked directly to significant improvements in quality at lower healthcare costs. Old conventions die hard, especially in the realm of CVD. However, the lessons of recent seminal trials (FAME, COURAGE, SYNTAX, AFFIRM and FAME 2) clearly indicate that movement along this continuum from anatomy to a robust, comprehensive construct for SIHD is necessary. SIHD and its sequelae still represent the largest segment of CVD, the greatest contributor to death from CVD and the greatest cost center for CVD care. Despite the required disruptive changes this vision entails, it is the right direction to take scientifically, economically and for CVD patients.
Future Cardiol. 2014;10(1):63-79. © 2014 Future Medicine Ltd.