Coronary Artery Disease (CAD)

Overview

Coronary Artery Disease (CAD) remains one of the leading causes of death globally. It affects individuals of all ages, particularly those with risk factors such as smoking, high-fat diets, physical inactivity, and chronic conditions like diabetes and hypertension.

CAD develops from the accumulation of plaque—composed of fat, calcium, and tissue debris—along the walls of the coronary arteries. This narrows the arteries, reducing blood flow to the heart muscle and leading to symptoms such as chest pain and shortness of breath. In severe cases, it can cause acute myocardial infarction (heart attack), which can be fatal.

Causes of Coronary Artery Disease

• High Cholesterol and Blood Pressure
  Leads to hardening and narrowing of the arteries
• Smoking
  Nicotine and carbon monoxide increase heart strain and blood clot risk
• Diabetes
  Doubles the risk of developing CAD by accelerating plaque buildup

Symptoms of Coronary Artery Disease

• Chest Pain (Angina)
  A sensation of pressure or tightness in the chest
• Shortness of Breath
  Due to weakened heart function and poor blood circulation
• Heart Attack (Acute Myocardial Infarction)
  Occurs when a coronary artery becomes completely blocked, cutting off blood supply to part of the heart

Diagnosis and Treatment

• Cardiac Catheterization
  A catheter is inserted through the wrist (radial artery) or groin (femoral artery) to evaluate coronary artery blockages. The radial approach is now preferred due to fewer complications and faster recovery.

Personalized treatment approaches

• Quantitative Coronary Analysis (QCA)
  Uses imaging to measure the degree of arterial narrowing accurately.
• Fractional Flow Reserve (FFR)
  Measures pressure differences across a narrowed section. A value below 0.80 indicates insufficient blood flow, signaling the need for intervention.
• Quantitative Flow Ratio (QFR)
  An emerging technology combining QCA and FFR techniques without the need for pressure wires.

Treatment Selection based on SYNTAX Score

Treatment depends on disease severity and the complexity of artery involvement, often guided by the SYNTAX score:

• Low SYNTAX Score (1–2 vessel disease)
  Treated with balloon angioplasty or stent placement
• High SYNTAX Score (complex or multi-vessel disease)
  Managed by a Heart Team through Coronary Artery Bypass Grafting (CABG)