Beyond Percutaneous Coronary Intervention - Targeted Molecular Therapies for the Next Era of Coronary Care

Coronary artery disease (CAD) remains the leading global cause of cardiovascular morbidity and mortality, driven by dysregulated lipid metabolism, chronic vascular inflammation, thrombosis, and genetic susceptibility. Management has long relied on mechanical revascularization-percutaneous coronary intervention and coronary artery bypass grafting supported by antithrombotic therapy. While these restore perfusion and reduce ischemic events, they do not address atherogenesis at the molecular level and leave substantial residual risk, often with increased bleeding. Advances in genomics, proteomics, lipidomics, inflammation biology, and artificial intelligence are transforming understanding of CAD pathophysiology and therapy. These innovations support a shift toward “pharmacological revascularization,” extending beyond luminal repair to molecular plaque stabilization, inflammation modulation, metabolic correction, and sustained reduction of atherothrombotic risk. This review integrates evidence from multi-omics, advanced vascular imaging, and targeted therapies-including lipid-modifying, metabolic, anti-inflammatory, RNA-based, and gene-editing approaches-to propose a precision, data-driven framework focused on long-term restoration of vascular health.