What to Do with Epicardial Coronary Artery Abnormalities That do not Result in Myocardial Ischemia?

Abstract

When epicardial arteries with minimal CAD do not limit flow are found at coronary angiography, all cardiologists agree that aggressive risk factor modification and use of appropriate drugs are warranted. Some consider plaque sealing of minor coronary lesions with balloon angioplasty to prevent future infarction. Others believe that a coronary lesion that does not cause ischemia should not have the plaque sealed but should have FFR and the non-ischemia producing stenosis should be treated with aggressive risk factor modification (DEFER study). Evidence based data e.g. DEFER, relates to populations, not the individual. Thus these data provide guidelines, which are suggestions for decision making. The weight of evidence favors angioplasty/stent for epicardial vessels that result in myocardial ischemia. Sealing of non flow limiting plaques with angioplasty must await further information derived from invasive and non invasive studies.