Clinical Pathway for Coronary Atherosclerosis in Patients Without Conventional Modifiable Risk Factors: JACC...

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Pathway Development

Background:

• Coronary artery disease (CAD) poses a global health challenge, with standard modifiable cardiovascular risk factors (SMuRFs) being key targets for reduction.
• A significant subset of patients develop coronary atherosclerosis without identifiable SMuRFs.
• These SMuRFless patients experiencing myocardial infarction exhibit unexpectedly higher early mortality than those with SMuRFs, highlighting a gap in management strategies.

Purpose of the Study:

• To develop an evidence-based clinical pathway specifically for managing patients with SMuRFless coronary artery disease (CAD).
• To address the lack of established optimal management guidelines for this unique patient cohort.
• To improve clinical outcomes through enhanced secondary prevention and identification of previously unrecognized modifiable risk factors.

Main Methods:

• An international, multidisciplinary team was convened to create the clinical pathway.
• A modified Delphi method was employed to achieve consensus on the pathway's components.
• The pathway includes confirmation of atherosclerosis and SMuRFless status, evidence-based secondary prevention, and consideration of additional diagnostic tests and interventions.

Main Results:

• The developed pathway provides a structured approach for the diagnosis and management of SMuRFless CAD.
• It emphasizes rigorous adherence to evidence-based secondary prevention strategies.
• The pathway incorporates methods for identifying less typical or overlooked modifiable risk factors in this population.

Conclusions:

• A dedicated clinical pathway is crucial for the previously overlooked population of SMuRFless CAD patients.
• Implementation of this pathway, supported by a registry, is expected to enhance secondary prevention adherence.
• The pathway aims to improve patient outcomes by facilitating the diagnosis and management of additional modifiable risk factors in SMuRFless CAD.