Although coronary atherosclerosis (coronary artery disease) is a main cause of cardiac complications, including myocardial infarction, unstable and stable angina and sudden cardiac death, the link between the two is not univocal. Very often, coronary atherosclerosis does not translate into cardiac complications. Conversely – what we now would like to call, in a new comprehensive term – “myocardial ischemic syndromes” may recognize causes unrelated to the easily visible epicardial obstructive lesions. These may be explained by an interplay of vasoreactivity, inflammation, dissections, metabolic changes and – occasionally – extra-coronary or iatrogenic causes. Coronary causes may occur both in the large epicardial vessels and in the coronary microcirculation. Changes in myocardial metabolism may also cause or worsen myocardial ischemic syndromes. Most important, causes of myocardial ischemic syndromes often likely act in concert, also explaining the inadequacy of purely mechanical epicardial coronary interventions in “non-acute” myocardial ischemic syndromes. Recognizing the multiplicity of causes for myocardial ischemic syndromes paves the way to individualized, patient-tailored therapeutic approaches, clearly different in different settings.
This expert meeting will offer an update on risk factors, mechanisms, diagnostics and management of myocardial ischemic syndromes summoning a group of world-class experts with ample space devoted to discussions and interaction. An important aspect of the meeting will be devoted to proposing a new nomenclature of “myocardial ischemic syndromes”, overarching current terminologies, notably still different between European and American cardiological societies. The meeting is dedicated to a restricted number of cardiology, cardiac surgery and internal medicine specialists.
Raffaele De Caterina
Chair and Postgraduate School of Cardiology
University of Pisa
University Cardiology Division
Pisa University Hospital