Rethinking Stable Ischemic Heart Disease

Thomas Kuhn’s landmark book, The Structure of Scientific Revolutions, postulated that scientific progress proceeds linearly until the accumulation of a sufficient weight of evidence that the current paradigm is unable to accommodate forces the reexamination of underlying assumptions, and a new paradigm must be established (1). Viewed through this framework, stunning advances of past decades in identification and quantification of obstructive coronary artery disease (CAD) stenosis represent the success of the traditional belief that this condition underlies essentially all stable ischemic heart disease (SIHD) syndromes. However, there are now many “loose ends” that challenge this preoccupation equating obstructive stenosis with SIHD, suggesting that it may be time to rethink this scientific paradigm.