The Lancet Commission on rethinking coronary artery disease: moving from ischaemia to atheroma

作者：S. Zaman, J. Wasfy, V. Kapil, B. Ziaeian, William Parsonage, Sira Sriswasdi, Timothy J. A. Chico, D. Capodanno, R. Colleran, N. Sutton, Lei Song, N. Karam, R. Sofat, Chiara Fraccaro, Daniel Chamié, Mirvat A. Alasnag, T. Warisawa, Nieves Gonzalo, Walid Jomaa, Shamir R. Mehta, E. E. Cook, J. Sundström, S. Nicholls, L. Shaw, Manesh R. Patel, R. Al-Lamee · 发表于：The Lancet · 年份：2025 · DOI：10.1016/s0140-6736(25)00055-8 · 被引用次数：152 · 研究领域：Medicine

Executive summary Coronary artery disease has long been understood through the paradigm of epicardial coronary artery obstruction, causing myocardial ischaemia (a mismatch between myocardial blood supply and demand). However, this model, which focuses on diagnosing and managing coronary artery disease based on ischaemia and cardiovascular events, is flawed. By the time ischaemia manifests, it is often too late for optimal intervention, limiting the effectiveness of treatment options. Despite decades of medical advances, coronary artery disease continues to be a leading cause of morbidity and mortality globally, highlighting the inadequacy of this traditional ischaemic-centric approach. The central limitation of current approaches is the focus on the temporary solutions of restoring myocardial blood flow after obstruction, rather than tackling the underlying disease. Coronary artery disease, caused by atherosclerosis, often results in myocardial infarction through mechanisms that emerge earlier in the progression of disease. The focus of medical care has predominantly been on the recognition of symptoms and treatment of acute events, missing opportunities for early detection and prevention of disease. Billions of dollars in health-care funding continue to be spent on identifying and managing coronary ischaemia; yet, the dominant mechanisms for myocardial infarction are atherosclerotic plaque rupture or erosion and, to a lesser extent, erupted calcified nodules that can emerge ...