Clinical trials of coronary revascularization for chronic stable angina: medical treatment versus coronary revascularization.
For patients with chronic stable angina, several randomized trials have been performed comparing medical management with surgery, medical management with angioplasty, and angioplasty with surgery. Data from the medical versus revascularization trials (either surgery or angioplasty) support the following contentions: For patients with multivessel disease, particularly involving the proximal left anterior descending coronary artery, survival is superior to surgical treatment. Symptom relief with either type of revascularization is superior to medical management. The subsequent rate of myocardial infarction is not affected by the initial treatment strategy, whether medical, angioplasty, or surgery. In individual patients the potential benefits of any revascularization strategy must be weighed against its initial risks. Further study is needed, particularly with multifaceted pharmacologic therapy and with updated angioplasty techniques, to evaluate relative survival benefits in these patients. The studies supporting these conclusions are highlighted in this paper.
Parisi
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AF
The Miriam Hospital, Division of Cardiology, Providence, Rhode Island 02906, USA. aparisi@lifespan.org
D000787:Angina Pectoris / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D009204:Myocardial Revascularization; D016032:Randomized Controlled Trials as Topic