Coronary Artery Disease (CAD)

Basic Overview

Coronary artery disease, also known as ischemic heart disease, is the leading cause of death globally. It is characterized by atherosclerotic plaque buildup in the epicardial coronary arteries, causing reduced myocardial blood flow, myocardial ischemia, and potentially myocardial infarction (MI) and sudden cardiac death. It is classified into chronic coronary syndrome (CCS) (stable angina, ischemic cardiomyopathy) and acute coronary syndrome (ACS) (unstable angina, non-ST elevation MI (NSTEMI), ST elevation MI (STEMI)).

Etiology: The primary cause is coronary atherosclerosis, driven by non-modifiable risk factors (advanced age, male gender, genetic predisposition) and modifiable risk factors (hypertension, dyslipidemia, diabetes mellitus, smoking, obesity, sedentary lifestyle, excessive alcohol intake, chronic stress).
Clinical Manifestations:
- Stable CCS: Classic exertional angina pectoris (retrosternal chest pressure/pain radiating to the jaw, shoulder, or arm, precipitated by exertion and relieved by rest/nitroglycerin). Some patients present with atypical symptoms (dyspnea, fatigue, epigastric pain) or silent ischemia.
- ACS: Unstable angina presents with rest pain, new-onset severe angina, or accelerating angina. MI presents with severe persistent chest pain (>20 minutes) unrelieved by nitroglycerin, accompanied by dyspnea, diaphoresis, nausea, syncope, or cardiac arrest.
Diagnosis: Initial evaluation includes 12-lead ECG (critical for STEMI diagnosis) and cardiac troponin (gold standard for MI diagnosis). Non-invasive testing includes stress testing and coronary CTA. Invasive coronary angiography (ICA) is the gold standard for definitive stenosis assessment and revascularization planning.

Standard Treatment Modalities

Optimal Medical Therapy (OMT): The cornerstone of all CAD management, including:
- Antiplatelet therapy: Lifelong aspirin for all CAD patients, P2Y12 inhibitors for ACS or post-percutaneous coronary intervention (PCI), with dual antiplatelet therapy (DAPT) for guideline-specified durations.
- Lipid-lowering therapy: Statins, ezetimibe, and PCSK9 inhibitors, with a target LDL-C <1.4 mmol/L for very high-risk patients.
- Antianginal therapy: Beta-blockers, nitrates, calcium channel blockers, ranolazine, and ivabradine.
- Secondary prevention: RAAS inhibitors, strict glycemic control, and risk factor modification.
Myocardial Revascularization: Indicated for refractory symptoms despite OMT, high-risk anatomy, or ACS.
PCI: The first-line minimally invasive procedure, involving balloon angioplasty and drug-eluting stent (DES) implantation. Primary PCI is the gold standard for STEMI, with a target door-to-balloon time <90 minutes.
Coronary Artery Bypass Grafting (CABG): The gold standard surgical procedure, recommended for left main disease, 3-vessel disease, or diabetes, with superior long-term survival vs. PCI in high-risk groups. Minimally invasive and off-pump CABG are widely used to reduce trauma.

Core Advantages of Treatment in China

Largest Global PCI Volume and Complex Lesion Expertise

China performs the highest number of PCI procedures worldwide, with over 1.2 million completed annually. Chinese interventional cardiologists have unparalleled global experience in complex lesions, including chronic total occlusion (CTO), left main disease, bifurcation lesions, and calcified lesions. CTO-PCI success rates exceed 90% in leading centers.

World's Largest Chest Pain Center Network

China has over 5000 certified chest pain centers nationwide, standardizing pre-hospital triage, rapid diagnosis, and emergency reperfusion for STEMI. The national average door-to-balloon time is <75 minutes in certified centers.

Domestic Device Innovation

Chinese clinicians and manufacturers are global leaders in developing next-generation DES, bioresorbable vascular scaffolds (BRS), intravascular lithotripsy (IVL), and intracoronary imaging systems (IVUS, OCT).

Mature Minimally Invasive CABG Expertise

Chinese cardiac surgeons have extensive experience in off-pump CABG, minimally invasive direct coronary artery bypass (MIDCAB), and hybrid revascularization (PCI + CABG).

Evidence-Based TCM Integration

TCM herbal medicines (e.g., Tongxinluo Capsule, Danshen Dropping Pills) have been validated in large-scale Chinese trials to improve myocardial microcirculation, reduce angina, and improve clinical outcomes.

East Asian-Tailored Antithrombotic Protocols

Chinese guidelines optimize DAPT dosing and duration for East Asian patients, who have a higher bleeding risk with antiplatelet therapy and differential clopidogrel pharmacogenomics.

Exceptional Cost-Effectiveness

PCI and CABG in China cost 1/4 to 1/6 of that in the U.S. or Europe, with high-quality domestic DES at 1/3 to 1/2 the price of imported devices.