Contemporary revascularization strategy and state-of-the-art technologies for treatment of patients with coronary artery disease

The contemporary management flow of patients with coronary artery disease (CAD) has become increasingly complex. Coronary revascularization, namely percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) have evolved substantially through the advancement of new technologies and the emergence of new evidence. Nevertheless, the clinical significance of coronary revascularization in improving patient outcomes remains a matter of debate, even in the current era, especially for chronic coronary syndrome. In this regard, we have to reconsider the remaining challenges in contemporary revascularization strategy to re-establish their clinical efficacy.
The treatment flow consists of two core elements: the individual assessment of a patient/lesion, and the selection of an appropriate strategy from the available treatment options. In the current thesis, we investigated the novel risk stratification methodology and state-of-the-art technologies to further improve the treatment flow. For the patient-level assessment, we sought to explore a more comprehensive risk-stratification method, incorporating patients’ self-reported physical and mental health, in contrast to the currently utilized criteria based only on a few clinical characteristics. The new risk-assessment tool could support decision-making to select an appropriate revascularization mode. For the lesion-level assessment, we introduced novel imaging technologies to meticulously assess plaque morphology, physiological function, and superficial wall strain/stress. These tools would enable the identification of high-risk lesions and maximize the treatment effects of PCI and CABG. Furthermore, we evaluated the upcoming state-of-the-art treatment technologies to overcome current stent- or graft-related complications. These advancements are expected to redefine the role of coronary revascularization in the near future.