title: How and when to decide on revascularization in stable ischemic heart disease.
abstract: Coronary artery disease is the leading cause of death and disability worldwide. While an invasive strategy of early revascularization reduces cardiovascular morbidity and mortality in patients with acute coronary syndromes, there is no convincing evidence that this strategy leads to an incremental survival advantage for patients with stable ischemic heart disease (SIHD) beyond that achieved by optimal medical therapy. Two landmark trials, COURAGE and BARI 2D, suggest that a strategy of aggressive medical therapy is a reasonable initial approach to such patients. However, there remain certain groups of patients, those with at least moderate ischemia on baseline stress testing, where there is still clinical equipoise. Major society guidelines favor revascularization based on observational data and trials of CABG conducted decades ago, yet data from modern randomized trials are lacking. Ongoing trials such as ISCHEMIA should provide clinicians with evidence to guide selection of the appropriate initial management strategy for patients with SIHD.
authors.affiliation: Leon Charney Division of Cardiology, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY, 10016, USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Mecklai
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
authors.forename: Judith
authors.initials: J
authors.lastname: Hochman