title: Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when to revascularize.
abstract: Patients with acute coronary syndromes and severe multivessel or left main coronary artery disease have better outcomes when prompt revascularization is performed in addition to optimal medical therapy (OMT). However, in patients with stable ischemic heart disease, randomized strategy trials have revealed equipoise between initial strategies of OMT alone and OMT plus revascularization. Conducted in diverse stable ischemic heart disease patient populations and throughout the spectrum of atherosclerotic and ischemic burden, the RITA-2, MASS II, COURAGE, BARI 2D and FAME 2 trials demonstrate that OMT alone and OMT plus revascularization yield similar outcomes with respect to mortality and myocardial infarction. What remains unclear is whether there may be one or more subsets of patients with stable ischemic heart disease in whom revascularization may be associated with a reduction in mortality or myocardial infarction, which is to be addressed in the ongoing ISCHEMIA trial.
authors.affiliation: Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA.|Albany Medical College, Albany, NY, USA.
authors.forename: Mikhail T
authors.initials: MT
authors.lastname: Torosoff
authors.affiliation: Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA.|Albany Medical College, Albany, NY, USA.|Samuel S Stratton VA Medical Center, 113 Holland Street, Albany, NY, USA.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Karan P
authors.initials: KP
authors.lastname: Desai
authors.affiliation: Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA.|Albany Medical College, Albany, NY, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Fein
authors.affiliation: Division of Cardiology, Department of Medicine, Albany Medical Center, Albany, NY, USA.|Albany Medical College, Albany, NY, USA.|Samuel S Stratton VA Medical Center, 113 Holland Street, Albany, NY, USA.
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
mesh_terms: D003324:Coronary Artery Disease / Q000628:therapy*; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
keywords: coronary anatomy; coronary artery disease; ischemia; myocardial ischemia; optimal medical therapy; revascularization; stable ischemic heart disease