Coronary Artery Disease

  • Nages Nagaratnam
  • Kujan Nagaratnam
  • Gary Cheuk
Reference work entry


Coronary heart disease (CHD) is the largest cause of death and disability and the largest single cause of death in Australia and accounted for 21% of all deaths in 2000 and 19% of all deaths in 2004. A single aetiology is rarely found in the majority of old people with CHD. The risks for coronary artery disease increase with age. The damage to the endothelial lining is most often caused by a combination of the following: hypertension, high blood cholesterol, smoking and diabetes. This review discusses the risk factors followed by an update on the clinical management. A large proportion of elderly patients with myocardial ischaemia have atypical manifestations including dyspnoea and worsening heart failure in addition to an excess occurrence of unstable angina and non-Q wave myocardial infarction. Early diagnosis and prompt treatment are vital in patients with STEMI. Preventing heart disease is an important part of overall management.


Coronary heart disease Risk factors Unstable angina Acute coronary syndromes(ACS) Unexpected sudden death ST-elevation myocardial infarction (STEMI) 


  1. 1.
    Australian Institute of Health and Welfare. Coronary heart disease. 2006. retrieved on 23 November, 2007.
  2. 2.
    AIHW, 2003. Australian Institute of Health and Welfare. Secondary prevention and rehabilitation after coronary events or stroke: A review of monitoring issues. Australian Institute of Health and Welfare, Canberra, ACT .Google Scholar
  3. 3.
    Mathur S. Epidemic of coronary heart disease and its treatment in Australia Cardiovascular Disease Series. no 20. Australian Institute of Health and Welfare, Canberra, 29.51.Google Scholar
  4. 4.
    Statistics about coronary heart disease. retrieved on 23 November, 2007.
  5. 5.
    Wenger NK Cardiovascular Disease in the Octogenarians and beyond. London: Martin Dunitz Ltd 1999.Google Scholar
  6. 6.
    National centre for Health Statistics. Current estimates for National Health Intervention Survey 1995. Hyattsville, Md US Department of Health and Human Services CDC, 1998, DHS publication No (PHS) 98–12527.Google Scholar
  7. 7.
    Bunker SJ, Colquhorn DM, Esler MD, Hickie IB, Hunt D, Jelineck VM, et al. National Heart Foundation of Australia position statement. “Stress” and coronary heart disease: psychosocial risk factors. MJA. 2003 178(6):272–27.PubMedGoogle Scholar
  8. 8.
    Tegos TJ, Kalodiki E, Sabetai MM, Nicholaides AN. The genesis of atherosclerosis and risk factors. A review. Angiology 2001;52:89–94.CrossRefPubMedGoogle Scholar
  9. 9.
    Yusuf S, Hawken S, Ounpuu S on behalf of the INTERHEART Study Investigators. Effect of potentially modifiable risk factors with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364:937–952.CrossRefPubMedGoogle Scholar
  10. 10.
    Rosengren A, Hawken S, Ounpuu S, Sliwa TL, Zubaid M, Almahmeed WA, for the INTERHEART investigators, et al. Association of Psychosocial risk factors with risk of acute myocardial infarction in 11,119 cases and 13,648 controls from 52 countries (the INTERHEART Study): case-control study. Lancet. 2004;304:953–962.CrossRefGoogle Scholar
  11. 11.
    Ettinger WH, Wahl PW, Kuller LH, Bush TL, Tracy RP, Manolio TA, et al. Lipoprotein lipids in older people: Results from Cardiovascular Health Study. The CHS Collaborative Research Group. Circulation. 1992;86(3):858–859.CrossRefPubMedGoogle Scholar
  12. 12.
    Kumar V, Cotran RS, Robbins SL. Basic Pathology Fifth. WB Saunders Company, Philadelphia 1992.Google Scholar
  13. 13.
    National Heart Foundation of Australia position statement. ‘Stress’ and coronary heart disease: psychosocial risk factors. MJA. 2003;178(6):272–276.2003.Google Scholar
  14. 14.
    Brezinka V, Kittel F. Psychosocial factors of coronary heart disease in women: a review. Soc Sci Med. 1996;42:1351–65.CrossRefPubMedGoogle Scholar
  15. 15.
    ACC/AHA Pocket Guideline. Management of patients with chronic stable angina. March, 2003.Google Scholar
  16. 16.
    Davies MJ. Arterial thrombosis and acute coronary syndromes in Acute coronary syndromes. J Am Coll Cardiol. June 1999.Google Scholar
  17. 17.
    Doukky R, Calvin JE. Risk stratification in patients with unstable angina and non-ST segment elevation myocardial infarction: Evidence-based review. J Invasive Cardiol 2002;14(4). accessed 26 May 2016.
  18. 18.
    Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Eng J Med. 1992.; 326:242–250; 310–318.Google Scholar
  19. 19.
    Chesebrom JH,Toschi V, Lettino M, Gallo R, Badimon JJ, Fallon JF, et al. Evolving concepts in the pathogenesis and treatment of arterial thrombosis. Mt Sinai J Medicine. 1995;62:275–286.Google Scholar
  20. 20.
    Bhatia LC, Naik RH. Clinical profile of acute myocardial infarction in elderly patients. J Cardiovasc Dis Res. 2013;4(2):107–11.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Goch A, Misiewicz P, Rysz J, Banach M. The clinical manifestations of myocardial infarction in elderly patients. Clin Cardiol. 2009;32(6):E46–51.CrossRefPubMedGoogle Scholar
  22. 22.
    Corsini F, Seaglione A, Iacomino MM,Mascia G, Melorio S, Ricci C, et al. Acute myocardial infarction in the elderly. A case-control study in a younger population and review of literature. Monaldi Arch Chest Dis. 2006;66(1):13–9.PubMedGoogle Scholar
  23. 23.
    Braunwald E, Mark DB, Jones RH, Brown J, Brown L, Cheitlin MD, et al. Unstable angina: Diagnosis ad management. Rockville MD: Agency for Health Care Policy and Research and National Heart Lung and Blood Institute, US Public Health Service, US Department of Health and Human Services.1994:1 AHCPR Publication 94-0602.Google Scholar
  24. 24.
    Antman EM, Cohen M, Bernink PJLM, McCabe CH, Horacek T, Papuchio G, et al. The TIMI risk score for unstable angina /non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA. 2000;284:835–42.CrossRefPubMedGoogle Scholar
  25. 25.
    Granger CB, Goldberg RJ, Dabbous O, Pieper KS, Engle KA, Cannon CP, et al. Predictors of hospital mortality in the Global Registry of Acute Coronary events. Arch Intern Med. 2003;163;2345–53.CrossRefPubMedGoogle Scholar
  26. 26.
    Guruwitz JH, McLaughton JJ, Willson DJ, Guadagnoli E, Hauptman PJ, Gao X, et al. Delayed hospital presentation in patients who have had acute myocardial infarction. Ann Intern Med 1997;126:593–599.CrossRefGoogle Scholar
  27. 27.
    Paul SD, O’Gara PT, Malijoub ZA, diSalvo TG, O’Donnell CJ, Newell JB, et al, Geriatric patients with myocardial infarction, cardiac risk factor, profiles, presentation, thrombolysis, coronary interventions and prognosis. Am Heart J. 1996;131:70–75.CrossRefGoogle Scholar
  28. 28.
    Tresch DD, Brady WJ, Aufderheide TP, Lawrence SW, Williams KJ. Comparison of elderly and younger patients with out of hospital chest pain, clinical characteristics and acute myocardial infarction, therapy and outcomes. Arch Intern Med. 1996;156:1089–93.CrossRefPubMedGoogle Scholar
  29. 29.
    Graham SP, Vetrovic GW. Comparison of angiographic findings and demographic variables in patients with coronary artery disease presenting with acute pulmonary oedema versus those presenting with chest pain. Am J Cardiol. 1991;68:1614–18.CrossRefPubMedGoogle Scholar
  30. 30.
    Stone GW, Griffin B, Shah P, Berman DS, Siegel RJ, Cook SI, et al. Prevalence of unsuspected myocardial infarction and left ventricular dysfunction in patients with coronary artery disease and acute pulmonary oedema associated with normal or depressed left ventricular systolic function. Am J Cardiol. 1991;67:37–41.CrossRefPubMedGoogle Scholar
  31. 31.
    Weaver WD. Time to thrombolytic therapy: Factors affecting delay and their influence on outcome. J Am Coll Cardiol 1995;125:(Suppl) 3S–9S.CrossRefGoogle Scholar
  32. 32.
    Newby LK, Rutschild R, Califf RM, Simoons ML, Aylward PE, Armstrong PW, et al. Time from symptom onset to treatment and outcomes after thrombolytic therapy. J Am Coll Cardiol 1996;27:1646–1655.CrossRefPubMedGoogle Scholar
  33. 33.
    Hong MK. Recent Advances in the Treatment of ST-Segment Elevation Myocardial Infarction. Scientifica 2012(2012), Article ID 683683, 13 pages.
  34. 34.
    Danchin P, Coste J, Ferrieres J, Steg PG, Cottlin Y, Blanchard D, et al. Comparison of thrombolysis followed by broad use of percutaneous coronary intervention with primary percutaneous coronary intervention for ST-segment-elevation acute myocardial infarction: data from the French registry on acute ST-elevation myocardial infarction (FAST-MI). Circulation. 2008;118(3):268–276.CrossRefPubMedGoogle Scholar
  35. 35.
    Zahari AM. Myocardial Infarction Treatment & Management. 2014. Retrieved on 9 December 2014.
  36. 36.
    Zhu B, Effron MB, Kulkarni MP, Jakubowski JA, Miller DL, Baker BA, et al. The onset of inhibition of platelet aggregation with prasugrel with clopidogrel loading doses using gatekeeping analysis of integrated clinical pharmacological data. J Cardiovasc Pharmacol. 2011;57:317–24.CrossRefPubMedGoogle Scholar
  37. 37.
    Gurbel PA, Bliden KP, Butler K, Tantry US, Geshe HT,Wei C, et al. Randomized double-blind assessment of the ONSET and OFFSET of the antiplatelet effects of ticagrelor versus clopidogrel in patients with stable coronary artery disease: the ONSET/OFFSET study. Circulation. 2009;120:2577–85.CrossRefPubMedGoogle Scholar
  38. 38.
    Shanmugam VB, Haroer R, Meredith I, Malaiapan Y, Psaltis PJ. An overview of PCI in the very elderly. Journal of Geriatric Cardiology (2015)12:174–184.PubMedPubMedCentralGoogle Scholar
  39. 39.
    TIME investigators. Trial of Invasive versus Medical Therapy in Elderly patients with chronic symptomatic coronary artery disease. Lancet 2001;358(9286):951–7.CrossRefGoogle Scholar
  40. 40.
    Devlin G, Gore JM, Elliot J, Wijesinge N, Eage KA, Avezum R, et al. Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation Acute coronary syndromes. The global registry of acute coronary events. European Heart Journal 2008;29:1275–82.CrossRefPubMedGoogle Scholar
  41. 41.
    De Boer SP, Barnes EH, Westerhout CM,Simes RJ, Granger CB, Kestrati A, et al. High-risk patients with ST-elevation myocardial infarction derive greatest absolute benefit from primary percutaneous coronary intervention: results from the primary coronary angioplasty trialist versus thrombolysis (PCAT)-2 collaboration. America Heart Journal 2011;161:500–507.CrossRefGoogle Scholar
  42. 42.
    Belder AD, Hernandez JMDLT, Lopez-Palop R, O’Kane, Hernanadez FH, Strange J, et al. A prospective randomised trial of everolimus-eluting stents versus bare-metal stents in octogenarians. Journal of American College Cardiology 2014;63:1371–1375.CrossRefGoogle Scholar
  43. 43.
    Piper WD, Malenka DJ, Ryan TJ,Shubroos SJ, O’Connor GT, Robb JF, et al, Predicting vascular complications in percutaneous coronary interventions. American Heart Journal 2003;145:1022–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Shan L, Saxena A, MaMahon R, Newcomb, A, Coronary Artery Bypass Graft Surgery in the Elderly: A Review of Postoperative Quality of Life. Circulation. 2013;128:2333–2343.CrossRefPubMedGoogle Scholar
  45. 45.
    EUROASPIRE Study Group. European Society of Cardiology survey for secondary prevention of coronary heart disease: principal results. EUROASPIRE study Group. European Action on Secondary Prevention through intervention to reduce events. Eur Heart J. 1997;18:1569–82.CrossRefGoogle Scholar
  46. 46.
    Wood DA, de Backer G, Faergeman O, Graham Mancia G, Pyorala K and members of the Task Force. Prevention of coronary heart disease in clinical practice. Recommendations of the Second Joint Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Eur Heart J. 1998;19:1434–1503.CrossRefGoogle Scholar
  47. 47.
    Taylor CB, Miller NH, Killen JD, de Busk RF. Smoking cessation after acute myocardial infarction: effects of a nurse-managed intervention. Ann Int Med 1990;113:118–123.CrossRefPubMedGoogle Scholar
  48. 48.
    DeBusk RF, Houston Miller N, Superko HR, Dennis CA, Thomas RJ, Lew HT, et al. A case management system for coronary risk factor modification after acute myocardial infarction. Ann Int Med. 1994;120:721–729.CrossRefPubMedGoogle Scholar
  49. 49.
    SHEP Cooperative Research Group: Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA. 1991;265:3255–60.CrossRefGoogle Scholar
  50. 50.
    Staessen JA, Fagard R, Thijis L, Celis H, Arabidze GG, Birkenhager WH, et al. Morbidity and mortality in the placebo-controlled European Trial on Isolated Systolic Hypertension in the Elderly. Lancet. 1997;350:757–64.CrossRefPubMedGoogle Scholar
  51. 51.
    Shepherd J, Blauw GJ, Murphy MB, Bollen EI, Buckley BM, Cobbs SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomized controlled trial. Lancet. 2003;360:1623–30.CrossRefGoogle Scholar
  52. 52.
    Collins R, Armitage J, Parish S, Sleight P, Peto R, Heart Protection Study Group. Effects of cholesterol lowering with simvastatin on stroke and other major vascular events in 20536 people with cerebrovascular disease or other high-risk conditions. Lancet. 2004;363:757–87.CrossRefPubMedGoogle Scholar
  53. 53.
    Coronary Heart Disease, Statistics. A compendium of health statistics. 2012 edition. Published by the British Heart Foundation. Greater London House.180 Hampstead Road. London NW1 7AW.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Nages Nagaratnam
    • 1
  • Kujan Nagaratnam
    • 1
  • Gary Cheuk
    • 2
  1. 1.The University of SydneyWestmead Clinical SchoolWestmeadAustralia
  2. 2.Rehabilitation and Aged Care ServiceBlacktown-Mt Druitt HospitalMount DruittAustralia

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