Dasaad Mulijono*
Volume6-Issue8
Dates: Received: 2025-08-03 | Accepted: 2025-08-18 | Published: 2025-08-19
Pages: 1116-1122
Abstract
Despite advances in interventional cardiology, chronic coronary syndrome (CCS) remains a significant cause of morbidity and mortality globally, notably in resource-constrained healthcare systems like Indonesia. Traditional percutaneous coronary intervention (PCI) approaches, particularly stenting, have consistently failed to demonstrate substantial long-term benefits, as highlighted by landmark trials such as COURAGE, ORBITA, and ISCHEMIA, due to the frequent oversight of vulnerable plaques (VPs), incomplete revascularization (IR), procedural risks, and persistent complications. Bethsaida Hospital, under the visionary leadership of Prof. Dasaad Mulijono (DM), has pioneered a groundbreaking integrative strategy that combines drug-coated balloon (DCB) angioplasty, Plant-Based Diets (PBDs), and advanced computed tomography coronary angiography (CTCA).
This novel approach leverages CTCA’s precision in detecting and characterizing VPs non-invasively, enabling targeted and minimally invasive DCB interventions with remarkable procedural safety. Complementing these interventions, the systematic adoption of PBD addresses systemic inflammation and endothelial dysfunction, crucial drivers of atherosclerotic plaque instability. Clinical outcomes from over 2000 cases spanning five years demonstrated extraordinary results: complete elimination of stent thrombosis, dramatically reduced restenosis rates (<2%), negligible procedural complications, significantly decreased reliance on dual antiplatelet therapy, and notably, zero mortality in long-term follow-up.
Economically, Bethsaida’s integrative model has proved highly sustainable, reducing procedural complications, shortening hospitalization durations, and significantly lowering pharmaceutical expenditures. By establishing this evidence-based, cost-effective, and reproducible standard of care, Bethsaida Hospital offers a transformative paradigm that improves cardiovascular outcomes in Indonesia and presents a compelling model adaptable to global challenges in cardiovascular care.
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DOI: 10.37871/jbres2168
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© 2025 Mulijono D. Distributed under Creative Commons CC-BY 4.0
How to cite this article
Mulijono D. Breaking Boundaries in Chronic Coronary Syndrome Management: Bethsaida Hospital’s Integrative Approach Combining Drug-Coated Balloon, Plant-Based Diet, and Advanced Imaging. J Biomed Res Environ Sci. 2025 Aug 19; 6(8): 1116-1122. doi: 10.37871/jbres2168, Article ID: JBRES2168, Available at: https://www.jelsciences.com/articles/jbres2168.pdf
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References
- Harmadha WSP, Muharram FR, Gaspar RS, Azimuth Z, Sulistya HA, Firmansyah F, Multazam CECZ, Harits M, Putra RM. Explaining the increase of incidence and mortality from cardiovascular disease in Indonesia: A global burden of disease study analysis (2000-2019). PLoS One. 2023 Dec 15;18(12):e0294128. doi: 10.1371/journal.pone.0294128. PMID: 38100501; PMCID: PMC10723707.
- Jafary FH, Jafary AH. Ischemia Trial: Does the Cardiology Community Need to Pivot or Continue Current Practices? Curr Cardiol Rep. 2022 Aug;24(8):1059-1068. doi: 10.1007/s11886-022-01725-1. Epub 2022 Jun 2. PMID: 35653055; PMCID: PMC9161182.
- Jackson M, Zaman A. ORBITA: What Goes Around, Comes Around… Or Does It? Interv Cardiol. 2018 Sep;13(3):135-136. doi: 10.15420/icr.2018.18.2. PMID: 30443270; PMCID: PMC6234483.
- Teoh Z, Al-Lamee RK. COURAGE, ORBITA, and ISCHEMIA: Percutaneous Coronary Intervention for Stable Coronary Artery Disease. Interv Cardiol Clin. 2020 Oct;9(4):469-482. doi: 10.1016/j.iccl.2020.07.003. PMID: 32921371.
- Patel DB, Shah R, Jovin IS. Improving outcomes of percutaneous coronary interventions in patients with stable ischemic heart disease. J Thorac Dis. 2020 Apr;12(4):1740-1749. doi: 10.21037/jtd.2019.11.17. PMID: 32395316; PMCID: PMC7212146.
- Laukkanen JA, Kunutsor SK. Revascularization versus medical therapy for the treatment of stable coronary artery disease: A meta-analysis of contemporary randomized controlled trials. Int J Cardiol. 2021 Feb 1;324:13-21. doi: 10.1016/j.ijcard.2020.10.016. Epub 2020 Oct 15. PMID: 33068645.
- Napoli G, Mushtaq S, Basile P, Carella MC, De Feo D, Latorre MD, Baggiano A, Ciccone MM, Pontone G, Guaricci AI. Beyond Stress Ischemia: Unveiling the Multifaceted Nature of Coronary Vulnerable Plaques Using Cardiac Computed Tomography. J Clin Med. 2024 Jul 22;13(14):4277. doi: 10.3390/jcm13144277. PMID: 39064316; PMCID: PMC11278082.
- Kitada R, Otsuka K, Fukuda D. Role of plaque imaging for identification of vulnerable patients beyond the stage of myocardial ischemia. Front Cardiovasc Med. 2023 Mar 17;10:1095806. doi: 10.3389/fcvm.2023.1095806. PMID: 37008333; PMCID: PMC10063905.
- Hafiane A. Vulnerable Plaque, Characteristics, Detection, and Potential Therapies. J Cardiovasc Dev Dis. 2019 Jul 27;6(3):26. doi: 10.3390/jcdd6030026. PMID: 31357630; PMCID: PMC6787609.
- Fukase T, Dohi T. Visualization of Vulnerable Coronary Plaque and Prevention of Plaque Rupture. Juntendo Iji Zasshi. 2024 Jun 15;70(4):260-268. doi: 10.14789/jmj.JMJ24-0011-R. PMID: 39431179; PMCID: PMC11487368.
- Stone GW, Ali ZA, O'Brien SM, Rhodes G, Genereux P, Bangalore S, Mavromatis K, Horst J, Dressler O, Poh KK, Nath RK, Moorthy N, Witkowski A, Dwivedi SK, Bockeria O, Chen J, Smanio PEP, Picard MH, Chaitman BR, Berman DS, Shaw LJ, Boden WE, White HD, Fremes SE, Rosenberg Y, Reynolds HR, Spertus JA, Hochman JS, Maron DJ; ISCHEMIA Research Group. Impact of Complete Revascularization in the ISCHEMIA Trial. J Am Coll Cardiol. 2023 Sep 19;82(12):1175-1188. doi: 10.1016/j.jacc.2023.06.015. Epub 2023 Jul 17. PMID: 37462593; PMCID: PMC10529674.
- Mavromatis K, Jones PG, Ali ZA, Stone GW, Rhodes GM, Bangalore S, O'Brien S, Genereux P, Horst J, Dressler O, Goodman S, Alexander K, Mathew A, Chen J, Bhargava B, Uxa A, Boden WE, Mark DB, Reynolds HR, Maron DJ, Hochman JS, Spertus JA; ISCHEMIA Research Group. Complete Revascularization and Angina-Related Health Status in the ISCHEMIA Trial. J Am Coll Cardiol. 2023 Jul 25;82(4):295-313. doi: 10.1016/j.jacc.2023.05.025. PMID: 37468185; PMCID: PMC10551823.
- Stone GW, Ali ZA, Hochman JS, Maron DJ. REPLY: Interpreting the Impact of Complete Revascularization in the ISCHEMIA Trial. J Am Coll Cardiol. 2024 Jan 30;83(4):e39-e40. doi: 10.1016/j.jacc.2023.11.018. PMID: 38267120.
- Iqbal MB, Moore PT, Nadra IJ, Robinson SD, Fretz E, Ding L, Fung A, Aymong E, Chan AW, Hodge S, Webb J, Sheth T, Jolly SS, Mehta SR, Sathananthan J, Wood DA, Della Siega A; British Columbia Cardiac Registry Investigators. Complete revascularization in stable multivessel coronary artery disease: A real world analysis from the British Columbia Cardiac Registry. Catheter Cardiovasc Interv. 2022 Feb;99(3):627-638. doi: 10.1002/ccd.29564. Epub 2021 Mar 4. PMID: 33660326.
- Al-Lamee RK, Foley M, Rajkumar CA, Francis DP. Revascularization in stable coronary artery disease. BMJ. 2022 Jun 13;377:e067085. doi: 10.1136/bmj-2021-067085. PMID: 35697356.
- Leopold JA. Complete Coronary Revascularization: A New Strategy to Improve Clinical Outcomes for Stable Coronary Artery Disease? J Am Coll Cardiol. 2023 Sep 19;82(12):1189-1191. doi: 10.1016/j.jacc.2023.07.008. PMID: 37704308.
- Gaba P, Gersh BJ, Ali ZA, Moses JW, Stone GW. Complete versus incomplete coronary revascularization: definitions, assessment and outcomes. Nat Rev Cardiol. 2021 Mar;18(3):155-168. doi: 10.1038/s41569-020-00457-5. Epub 2020 Oct 16. PMID: 33067581.
- Gössl M, Faxon DP, Bell MR, Holmes DR, Gersh BJ. Complete versus incomplete revascularization with coronary artery bypass graft or percutaneous intervention in stable coronary artery disease. Circ Cardiovasc Interv. 2012 Aug 1;5(4):597-604. doi: 10.1161/CIRCINTERVENTIONS.111.965509. PMID: 22896575.
- Glenn IC, Iacona GM, Mangi AA. Percutaneous Coronary Intervention with Stenting versus Coronary Artery Bypass Grafting in Stable Coronary Artery Disease. Int J Angiol. 2021 Aug 31;30(3):221-227. doi: 10.1055/s-0041-1735238. PMID: 34776822; PMCID: PMC8580606.
- van Veelen A, van der Sangen NMR, Henriques JPS, Claessen BEPM. Identification and treatment of the vulnerable coronary plaque. Rev Cardiovasc Med. 2022 Jan 20;23(1):39. doi: 10.31083/j.rcm2301039. PMID: 35092231.
- Ambrose JA, Sharma AV. Identifying and Treating Vulnerable Atherosclerotic Plaques. Am J Cardiol. 2023 Oct 15;205:214-222. doi: 10.1016/j.amjcard.2023.07.121. Epub 2023 Aug 21. PMID: 37611413.
- Ambrose JA, Sharma AV. Identifying and Treating Vulnerable Atherosclerotic Plaques. Am J Cardiol. 2023 Oct 15;205:214-222. doi: 10.1016/j.amjcard.2023.07.121. Epub 2023 Aug 21. PMID: 37611413.
- Alperi A, Antuna P, Almendárez M, Álvarez R, Del Valle R, Pascual I, Hernández-Vaquero D, Avanzas P. Perspectives in the Diagnosis, Clinical Impact, and Management of the Vulnerable Plaque. J Clin Med. 2025 Feb 25;14(5):1539. doi: 10.3390/jcm14051539. PMID: 40095464; PMCID: PMC11899957.
- Tomaniak M, Katagiri Y, Modolo R, de Silva R, Khamis RY, Bourantas CV, Torii R, Wentzel JJ, Gijsen FJH, van Soest G, Stone PH, West NEJ, Maehara A, Lerman A, van der Steen AFW, Lüscher TF, Virmani R, Koenig W, Stone GW, Muller JE, Wijns W, Serruys PW, Onuma Y. Vulnerable plaques and patients: state-of-the-art. Eur Heart J. 2020 Aug 14;41(31):2997-3004. doi: 10.1093/eurheartj/ehaa227. PMID: 32402086; PMCID: PMC8453282.
- Motoyama S, Ito H, Sarai M, Kondo T, Kawai H, Nagahara Y, Harigaya H, Kan S, Anno H, Takahashi H, Naruse H, Ishii J, Hecht H, Shaw LJ, Ozaki Y, Narula J. Plaque Characterization by Coronary Computed Tomography Angiography and the Likelihood of Acute Coronary Events in Mid-Term Follow-Up. J Am Coll Cardiol. 2015 Jul 28;66(4):337-46. doi: 10.1016/j.jacc.2015.05.069. PMID: 26205589.
- Sato Y, Motoyama S, Miyajima K, Kawai H, Sarai M, Muramatsu T, Takahashi H, Naruse H, Ahmadi A, Ozaki Y, Izawa H, Narula J. Clinical Outcomes Based on Coronary Computed Tomography-Derived Fractional Flow Reserve and Plaque Characterization. JACC Cardiovasc Imaging. 2024 Mar;17(3):284-297. doi: 10.1016/j.jcmg.2023.07.013. Epub 2023 Sep 27. PMID: 37768240.
- Tuso P, Stoll SR, Li WW. A plant-based diet, atherogenesis, and coronary artery disease prevention. Perm J. 2015 Winter;19(1):62-7. doi: 10.7812/TPP/14-036. Epub 2014 Nov 24. PMID: 25431999; PMCID: PMC4315380.
- Peña-Jorquera H, Cid-Jofré V, Landaeta-Díaz L, Petermann-Rocha F, Martorell M, Zbinden-Foncea H, Ferrari G, Jorquera-Aguilera C, Cristi-Montero C. Plant-Based Nutrition: Exploring Health Benefits for Atherosclerosis, Chronic Diseases, and Metabolic Syndrome-A Comprehensive Review. Nutrients. 2023 Jul 21;15(14):3244. doi: 10.3390/nu15143244. PMID: 37513660; PMCID: PMC10386413.
- Mehta P, Tawfeeq S, Padte S, Sunasra R, Desai H, Surani S, Kashyap R. Plant-based diet and its effect on coronary artery disease: A narrative review. World J Clin Cases. 2023 Jul 16;11(20):4752-4762. doi: 10.12998/wjcc.v11.i20.4752. PMID: 37583985; PMCID: PMC10424050.
- Salehin S, Rasmussen P, Mai S, Mushtaq M, Agarwal M, Hasan SM, Salehin S, Raja M, Gilani S, Khalife WI. Plant Based Diet and Its Effect on Cardiovascular Disease. Int J Environ Res Public Health. 2023 Feb 14;20(4):3337. doi: 10.3390/ijerph20043337. PMID: 36834032; PMCID: PMC9963093.
- Koutentakis M, Surma S, Rogula S, Filipiak KJ, Gąsecka A. The Effect of a Vegan Diet on the Cardiovascular System. J Cardiovasc Dev Dis. 2023 Feb 22;10(3):94. doi: 10.3390/jcdd10030094. PMID: 36975858; PMCID: PMC10052889.