Modern Approaches To Risk Stratification And Personalized Therapy Of Coronary Heart Disease

Abstract

The work aims to analyze modern approaches to risk stratification and personalized therapy of coronary heart disease (CHD) with an emphasis on the integration of clinical scales, modern imaging methods, genetic and biomarkers, as well as the development of an approximate algorithm for their combined use in real clinical practice. In the context of the updated ESC recommendations for the management of chronic coronary syndromes (CCS, CCS) 2024, risk-based tactics are considered as a key tool for choosing a diagnostic and therapeutic strategy in patients with coronary artery disease.  Based on the analysis of modern literature on the scales of anatomical and functional complexity of the coronary bed (SYNTAX, functional SYNTAX, CAD-RADS 2.0), computed tomographic coronary angiography (CT-CAG), fractional blood flow reserve (FFR/FFR-CT), as well as polygenic risk scores for coronary disease and new biomarkers, the integrated approach to risk stratification.  According to the results of the study, the phased addition of CT-CT and genetic scoring to the clinical model led to a significant risk reclassification (total NRI of about 20%) and an increase in the proportion of patients receiving high-intensity lipid-lowering therapy from 48% to 71%, with a moderate increase in the number of referrals for invasive coronary angiography. These data are consistent with published studies on the increased prognostic value of CT scans and polygenic scores in assessing the risk of coronary heart disease and choosing therapy. An algorithm has been formulated that assumes individualization of tactics depending on the overall clinical, anatomical, genetic and biochemical profile of the patient and is focused on a more accurate determination of indications for revascularization, the choice of the intensity of lipid-lowering therapy and the duration of antiplatelet treatment.