Myocardial Ischaemic Syndromes: Shifting from a Coronary-centric to a Substrate-based Nomenclature is More Accurate...

Area of Science:

• Cardiology
• Medical Classification Systems

Background:

• Current angina and myocardial ischaemia classifications focus heavily on epicardial coronary lesions.
• This vessel-based approach overlooks non-obstructive causes and 'silent' ischaemia, particularly in patients with microvascular dysfunction like those with diabetes.

Purpose of the Study:

• To advocate for a more accurate and inclusive classification of ischaemic syndromes.
• To propose a shift from a vessel-based to a substrate-based nomenclature.

Main Methods:

• Review and critique of existing classification systems for angina and myocardial ischaemia.
• Conceptual development of a new 'substrate-based' classification.

Main Results:

• The current classification is overly simplistic and restrictive, failing to encompass all causes of ischaemia.
• A substrate-based nomenclature, including both obstructive and non-obstructive causes, is presented as a superior alternative.

Conclusions:

• A new classification for myocardial ischaemic syndromes is needed to better represent the full spectrum of pathophysiologic causes.
• The proposed substrate-based approach promotes a unified, patient-centric understanding of ischaemia, encompassing both epicardial and non-epicardial aetiologies.