The management of stable angina.
Symptoms of chronic stable angina are easily identifiable and indicate that a patient is at increased risk of heart attack and death. In patients with less severe angina, medical treatments are as effective as more invasive treatments and produce better survival rates. There is little evidence that the main types of medical treatment differ in effectiveness. For patients at higher risk, invasive revascularisation procedures--coronary artery bypass grafting (CABG) and angioplasty--are more appropriate. CABG is slightly more effective than angioplasty. A high proportion of patients receiving angioplasty require re-treatment. The risk of recurrence and coronary events is reduced if patients who receive invasive procedures also have long-term low dose aspirin and cholesterol-lowering therapy. There is no clear evidence that intracoronary stents are more cost-effective than standard angioplasty. There is a need for evidence-based guidance to help determine referral thresholds for further investigation, and revascularisation procedures. There is evidence of inequality of access to testing and treatment, by gender, ethnic group and social class. Access should be monitored in order to promote equity.
Petticrew
M
M
NHS Centre for Reviews and Dissemination, York University, UK.
Turner-Boutle
M
M
Sheldon
T
T
D000787:Angina Pectoris / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D000800:Angioplasty, Balloon / Q000592:standards*; D001241:Aspirin / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000592:standards*; D019317:Evidence-Based Medicine; D017052:Hospital Mortality; D006779:Hospitals, Public; D006801:Humans; D008330:Management Audit; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D013222:State Medicine; D006113:United Kingdom / Q000453:epidemiology