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Subacute coronary artery occlusion: complexities of the grey zone

Michaella Alexandrou1, Yader Sandoval1, Fernando Alfonso2

  • 1Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 E 28th Street #300, Minneapolis, MN 55407, USA.

European Heart Journal
|January 6, 2026
PubMed

Insights

Managing obstructive epicardial coronary artery disease, especially subacute coronary occlusions (SCOs), requires tailored strategies. This review details SCO management, bridging acute and chronic coronary syndromes for better patient outcomes.

Area of Science:

  • Cardiology
  • Vascular Medicine

Background:

  • Obstructive epicardial coronary artery disease presents differently in acute (acute coronary syndromes) versus chronic (chronic coronary syndromes) settings.
  • Management strategies differ significantly, with acute occlusions often needing emergent revascularization and chronic occlusions typically managed with medical therapy.

Purpose of the Study:

  • To clarify the clinical challenges and management nuances of subacute coronary occlusions (SCOs).
  • To emphasize the need for individualized treatment approaches for SCOs, which fall between acute and chronic presentations.

Main Methods:

  • This review synthesizes current understanding of SCOs.
  • It analyzes the distinct clinical contexts of acute and chronic coronary syndromes.
  • It highlights the importance of case-by-case assessment for SCOs.

Main Results:

  • Subacute coronary occlusions (SCOs) represent a poorly defined but clinically significant group.
  • SCOs require careful, individualized assessment due to their intermediate nature.
  • Tailored strategies are crucial for optimizing SCO management.

Conclusions:

  • Effective management of obstructive coronary artery disease hinges on recognizing the spectrum from acute to chronic presentations.
  • Subacute coronary occlusions (SCOs) demand specific attention and tailored therapeutic strategies.
  • A case-by-case approach is essential for SCOs to mitigate risks and improve outcomes.

Keywords:
Coronary artery diseaseLate STEMISCOsSubacute coronary occlusions

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