Coronary artery disease
By The Treatment Registry editors
Atherosclerotic narrowing of coronary arteries causing ischaemia and angina. Treatment is staged from lifestyle and medical therapy through percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG). The choice between PCI and CABG in multi-vessel disease requires multidisciplinary heart-team assessment per current ACC/AHA guidance.
Clinical overview
Signs and symptoms
The most common symptom is chest pain or discomfort occurring predictably with activity, after eating, or at other set times; this is termed stable angina and reflects narrowing of the coronary arteries. Angina may also be felt as tightness, heaviness, pressure, numbness, fullness, or squeezing, can travel to the shoulder, arm, back, neck, or jaw, and occasionally resembles heartburn; it typically lasts less than a few minutes and improves with rest. Angina that changes in intensity, character, or frequency is termed unstable and may precede a myocardial infarction. Shortness of breath may occur, sometimes no symptoms are present, and in many cases the first sign is a heart attack. Signs of a heart attack include angina, shortness of breath, sweating, nausea or vomiting, and light-headedness. In females the most common symptom is shortness of breath, and symptoms often appear about ten years later than in males.
Causes and risk factors
Coronary artery disease results from atherosclerosis, a chronic inflammation of the arteries that causes them to harden and accumulate cholesterol-rich atheromatous plaques on the artery walls, narrowing the lumen and reducing blood flow to the heart muscle, which can produce ischaemia and myocardial infarction. Well-established risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, family history, psychological stress, and excessive alcohol consumption. About half of cases are linked to genetics, with a heritability estimated between 40% and 60%. Smoking is associated with about 36% of cases and obesity with about 20%, and smoking just one cigarette per day roughly doubles the risk; lack of exercise accounts for 7 to 12% of cases. Air pollution, both indoor and outdoor, is responsible for roughly 28% of deaths from the disease.
How it is diagnosed
Diagnosis depends largely on the nature of the symptoms and on imaging. The first investigation when coronary artery disease is suspected is an electrocardiogram, used for both stable angina and acute coronary syndrome, and a chest X-ray, blood tests, and resting echocardiography may also be performed. For stable symptomatic patients, non-invasive tests are chosen according to the risk profile: computed tomography angiography is the best test to rule out disease in low-risk patients, while functional methods such as PET, SPECT nuclear stress testing, and stress echocardiography are typically better to rule it in. Exercise ECG is inferior to non-invasive imaging because of false-negative and false-positive results. Invasive coronary angiography is used when non-invasive testing is inconclusive or indicates high event risk.
Who it affects
In 2015, coronary artery disease affected 110 million people and resulted in 8.9 million deaths, making up 15.6% of all deaths and making it the most common cause of death globally. It may affect individuals at any age but becomes dramatically more common with age, roughly tripling with each decade of life, and males are affected more often than females. In the United States in 2010, about 20% of those over 65 had the disease. The World Health Organization has reported ischaemic heart disease as the world's biggest killer, responsible for 13% of total deaths and rising to 9.1 million deaths in 2021.
Clinical overview sourced from encyclopaedic medical reference; see sources below. General information only — not a substitute for individual clinical assessment.
Treatment ladder
Conservative options are first-line where appropriate; surgical options are typically reserved for cases where lower-tier options are unsuitable or have failed. Decisions are individual and depend on clinical assessment.
Conservative
- Risk-factor modification and medical therapy
Smoking cessation, lipid lowering (statins), blood-pressure control, antiplatelet therapy (aspirin), antianginal medications (beta-blockers, calcium-channel blockers, nitrates). Foundation of all coronary disease management; often sufficient for stable angina without high-risk anatomy.
Procedural
- Percutaneous coronary intervention (PCI)
Catheter-based stent placement, with or without atherectomy. Less invasive than CABG; preferred in single-vessel disease and in many multi-vessel cases without left-main or complex multi-vessel disease.
Surgical
- Coronary artery bypass graft (CABG) · View procedure page
Surgical revascularisation using internal mammary artery and saphenous vein/radial artery grafts. Superior to PCI for left-main disease, complex multi-vessel disease, and diabetic patients with multi-vessel disease per AHA/ACC guidance.
Related procedures
Sources
- [1]2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization — ahajournals.org(accessed 2026-05-09)
- [2]Wikipedia — Coronary artery disease — en.wikipedia.org(accessed 2026-07-24)
- [3]STS Adult Cardiac Surgery Database — sts.org(accessed 2026-05-09)
Sources marked “on file” are held by The Treatment Registry but are not publicly accessible.