Evaluating medical, percutaneous coronary intervention, and coronary artery bypass surgery options for chronic angina: an update of the revised guidelines.
Medical therapy is the standard background treatment for all patients with chronic stable angina. Studies show that antianginal therapies such as late sodium channel blockers (ranolazine), beta-blockers, calcium channel blockers, and nitrates dispensed alone or in combination can alleviate angina and angina-equivalent symptoms. For risk reduction of ischemic events, modification of coronary risk factors with lifestyle modification and medical therapy is the cornerstone. Effective risk modification strategies include lipid management, smoking cessation, diabetes control, weight management, nutritional enhancements, and physical activity. The pursuit of a more definitive treatment for chronic angina should be guided by the patient's clinical presentation, results of imaging-based risk-stratification evaluations, response to medical therapies, and patient preference. Revascularization by percutaneous coronary intervention or coronary artery bypass surgery may be recommended for patients who have persistent and intolerable symptoms despite optimal medical therapy and for those who are likely to have a survival benefit from revascularization based on the severity and location of the atherosclerotic lesions.
Cannon
Christopher P
CP
Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA.
Waheed
Salman
S
D000787:Angina Pectoris / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D002317:Cardiovascular Agents