What is the treatment for coronary (coronary artery) disease?

From the Guidelines

Crown disease treatment should prioritize a combination of lifestyle and risk-factor modification, disease-modifying medications, and consideration of coronary revascularization if symptoms are refractory to medical treatment or if high-risk CAD is present, as recommended by the 2024 ESC guidelines for the management of chronic coronary syndromes 1.

Key Considerations

• The final step in managing chronic coronary syndromes includes lifestyle and risk-factor modification combined with disease-modifying medications, and coronary revascularization is considered if symptoms are refractory to medical treatment or if high-risk CAD is present 1.
• Treatment decisions regarding coronary revascularization in patients with coronary artery disease (CAD) should be based on clinical indications, regardless of sex, race, or ethnicity, and a multidisciplinary team approach is recommended for patients with unclear optimal treatment strategies 1.
• For patients with significant left main disease, surgical revascularization is indicated to improve survival relative to medical therapy, and percutaneous revascularization is a reasonable option in selected patients with low-to-medium anatomic complexity of CAD and left main disease 1.

Disease-Specific Treatment

• Microvascular angina and vasospastic angina require specific treatments, including baseline therapy with aspirin, statin, and ACEi, and antianginal therapy with beta blockers or calcium channel blockers, as outlined in the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease 1.
• Obstructive CAD requires consideration of revascularization and antianginal therapy as per guidelines, and noncardiac causes of chest pain should be excluded and investigated or referred to other specialties as appropriate 1.

Important Takeaways

• Early intervention is essential for successful management of crown disease, and treatment decisions should be patient-centered, incorporating patient preferences and goals, and including shared decision-making 1.
• The use of a radial artery as a surgical revascularization conduit is preferred versus the use of a saphenous vein conduit to bypass the second most important target vessel with significant stenosis after the left anterior descending coronary artery, due to superior patency, reduced adverse cardiac events, and improved survival 1.

From the Research

Crown Disease Treatment

• The treatment of crown disease often involves addressing the underlying cause of the infection, which can be related to the root canal or periapical region of the tooth 2, 3.
• Studies have shown that a variety of microorganisms, including anaerobic bacteria, can be present in these infections, and the susceptibility of these microorganisms to antibiotics can vary 2, 3.
• The use of systemic antibiotics in the treatment of symptomatic apical periodontitis and acute apical abscess is generally not recommended unless there is evidence of spreading infection or systemic involvement 4, 5.
• In cases where antibiotics are necessary, the choice of antibiotic and the duration of treatment should be based on the specific needs of the patient and the severity of the infection 4, 5.
• Other treatment options, such as endodontic therapy or surgical intervention, may also be necessary to address the underlying cause of the infection and prevent further complications 6, 3.

Antibiotic Use

• The use of antibiotics in the treatment of crown disease should be judicious and based on the presence of systemic involvement or a high risk of progression to systemic involvement 4, 5.
• The most commonly used antibiotics for the treatment of dental infections include amoxicillin, clindamycin, and penicillin 2, 4.
• The susceptibility of microorganisms to these antibiotics can vary, and the choice of antibiotic should be based on the specific needs of the patient and the severity of the infection 2, 3.

Treatment Outcomes

• The outcome of treatment for crown disease can vary depending on the severity of the infection and the effectiveness of the treatment 6, 3.
• Studies have shown that the use of systemic antibiotics in the treatment of symptomatic apical periodontitis and acute apical abscess can result in little to no difference in patient-reported pain or swelling 4.
• The prognosis for successful treatment is generally better when there is good initial orthograde root filling, an associated radicular cyst, and a deep buccal sulcus 6.