Ischaemia

Paradigm-shifting studies have revealed that the heart contains heterogeneous and dynamic immune and stromal cell populations that are crucial determinants of health and disease. Advances in molecular imaging now make it possible to non-invasively visualize the cardiac cellular landscape in humans, providing a means to guide precision therapies.

In ischaemic tissues, macrophages accumulate in the perivascular region and regulate blood flow by releasing nitric oxide derived from inducible nitric oxide synthase, thereby increasing muscle perfusion and improving limb function.

An initial invasive strategy in addition to medical therapy does not reduce the risk of death or nonfatal myocardial infarction or relieve angina symptoms compared with an initial conservative strategy with medical therapy alone in patients with stable coronary artery disease, moderate or severe ischaemia and advanced chronic kidney disease.

The addition of an invasive strategy (angiography plus revascularization when feasible) to medical therapy does not reduce the risk of cardiovascular events or death but might reduce symptoms of angina among patients with stable coronary artery disease and moderate or severe ischaemia.