Background The current approach to Ischemic Heart Disease is dictated by the assumption that myocardial ischemia is consistently associated with coronary atherosclerotic obstructions. This concept is so popular that the terms “coronary artery disease” and “ischemic heart disease” are used indifferently. Instrumental evidence of myocardial ischemia is diagnosed as a “false positive” if coronary angiography does not show an atherosclerotic obstruction. Conversely, a negative test is diagnosed as a “false negative” if a coronary lesion is demonstrated at angiography. However, the assumption of a close link between coronary atherosclerosis and myocardial ischemia is strongly challenged by many anatomical data and epidemiological reports. Based on these observations, the relevance of coronary atherosclerotic obstructions on ischemic syndromes will be discussed and a more comprehensive approach will be proposed. Objectives of the Summit This Summit will propose to Clinical and Interventional Cardiologists a critical re-assessment of the role of coronary atherosclerosis in the pathogenesis of myocardial ischemia. Alternative mechanisms of myocardial ischemia will be discussed and the impact of stenosis removal by PCI will be analyzed. A more comprehensive approach that considers the complex and multiple mechanisms contributing to myocardial ischemia will be proposed and its therapeutic implications will be discussed.
Mario Marzilli President of the Meeting