title: Challenges with Evidence-Based Management of Stable Ischemic Heart Disease.
abstract: Stable ischemic heart disease (SIHD) is a highly prevalent condition associated with increased costs, morbidity, and mortality. Management goals of SIHD can broadly be thought of in terms of improving prognosis and/or improving symptoms. Treatment options include medical therapy as well as revascularization, either with percutaneous coronary intervention or coronary artery bypass grafting. Herein, we will review the current evidence base for treatment of SIHD as well as its challenges and discuss ongoing studies to help address some of these knowledge gaps.
  
  
  
  There has been no consistent reduction in death or myocardial infarction (MI) with revascularization vs. medical therapy in patients with SIHD in contemporary trials. Angina and quality of life have been shown to be relieved more rapidly with revascularization vs. optimal medical therapy; however, the durability of these results is uncertain. There have been challenges and limitations in several of the trials addressing the optimal treatment strategy for SIHD due to potential selection bias (due to knowledge of coronary anatomy prior to randomization), patient crossover, and advances in medical therapy and revascularization strategies since trial completion. The challenges inherent to prior trials addressing the optimal management strategy for SIHD have impacted the generalizability of results to real-world cohorts. Until the results of additional ongoing trials are available, the decision for revascularization or medical therapy should be based on patients' symptoms, weighing the risks and benefits of each approach, and patient preference.
authors.affiliation: Division of Cardiology, New York University School of Medicine, New York, NY, 10016, USA.|, 550 1st Avenue, New York, NY, 10016, USA.
authors.forename: Amit V
authors.initials: AV
authors.lastname: Patel
authors.affiliation: Cardiac Catheterization Laboratory, Cardiovascular Outcomes Group, Cardiovascular Clinical Research Center, New York University School of Medicine, New York, NY, 10016, USA. sripalbangalore@gmail.com.
authors.forename: Sripal
authors.initials: S
authors.lastname: Bangalore
mesh_terms: D000787:Angina Pectoris / Q000517:prevention & control; D001026:Coronary Artery Bypass; D019468:Disease Management; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: Challenges; Management; Stable ischemic heart disease