Myocardial Ischaemic Syndromes: Shifting from a Coronary-centric to a Substrate-based Nomenclature is More Accurate and Inclusive.

This article highlights the rationale for a more accurate and inclusive classification that does not focus solely on epicardial coronary lesions as the for angina and myocardial ischaemia in all patients but rather represents a more comprehensive classification encompassing both obstructive and non-obstructive causes. Ischaemia may be 'silent' clinically or electrocardiographically and is observed in both acute and non-acute settings, as seen in patients with diabetes and other conditions associated with microvascular dysfunction. By pivoting away from the more restrictive and overly simplistic 'vessel-based' classification that disproportionately focuses on obstructed epicardial arteries to a 'substrate-based' nomenclature inclusive of both obstructive and non-obstructive causes, 'myocardial ischaemic syndromes' will better align and unify a patient-centric approach by harmonising the full spectrum of pathophysiologic causes.