The evolving role of medical therapy for chronic stable angina.
The management of chronic stable angina has undergone considerable evolution over the past two decades. This article highlights the need for a comprehensive approach to management that includes carefully identifying cardiac risk factors, using therapeutic lifestyle interventions, aggressive, multifaceted medical therapy, and judiciously using myocardial revascularization. For patients whose ischemia cannot be optimally controlled with traditional anti-ischemic agents, a novel antianginal and anti-ischemic agent (ie, ranolazine) has promise in reducing refractory ischemia as add-on therapy. This article discusses the role of coronary artery bypass graft surgery and percutaneous coronary intervention (PCI) in managing chronic stable angina patients and the clinical implications of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive drug Evaluation) trial. The combined use of a "focal" approach (PCI to treat the culprit stenosis) and a "systemic" approach (lifestyle intervention and aggressive pharmacotherapy) may afford the best event-free survival and clinical outcomes in patients with stable angina.
Eid
Freidy
F
Division of Cardiology, Buffalo General Hospital, SUNY at Buffalo School of Medicine, 100 High Street, Buffalo, NY 14203, USA.
Boden
William E
WE
D000083:Acetanilides / Q000627:therapeutic use; D000787:Angina Pectoris / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D018572:Disease-Free Survival; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D000069458:Ranolazine; D012307:Risk Factors; D040242:Risk Reduction Behavior
D000083:Acetanilides; D002317:Cardiovascular Agents; D004791:Enzyme Inhibitors; D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D000069458:Ranolazine