Document Detail

Management of stable coronary artery disease.
MedLine Citation:
PMID:  20189028     Owner:  NLM     Status:  MEDLINE    
Results of two randomised controlled trials for the management of mild-to-moderate chronic stable coronary artery disease (Clinical Outcomes Utilizing Revascularization and Aggressive drug Evaluation [COURAGE] and Bypass Angioplasty Revascularization Investigation type-2 Diabetes [BARI-2D]) have stimulated a vigorous debate about whether an initial strategy of revascularisation or a conservative approach with drugs is most effective. The conclusions of these two trials were clear: for some patients randomly assigned after angiography to revascularisation or pharmacological therapy, rates of death and myocardial infarction did not differ between the two strategies. What remains unresolved is how to generalise these data to patients without angiography, the role of stress testing, and the preferred approach to patients with relevant ischaemia on stress testing. This Review draws attention to the controversial issues in both management approaches, analyses the strengths and limitations of recent trials, and proposes a treatment algorithm that is applicable to daily clinical practice. Findings suggest that the severity of anginal symptoms and the extent of ischaemia in stress testing could help to identify patients who are at increased risk and who might benefit from an early invasive strategy. On the basis of the data and considerations presented, a strategy of initial optimum pharmacological therapy or direct invasive management can be tailored to an individual's circumstances and preferences.
Matthias E Pfisterer; Michael J Zellweger; Bernard J Gersh
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Lancet     Volume:  375     ISSN:  1474-547X     ISO Abbreviation:  Lancet     Publication Date:  2010 Feb 
Date Detail:
Created Date:  2010-03-01     Completed Date:  2010-03-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2985213R     Medline TA:  Lancet     Country:  England    
Other Details:
Languages:  eng     Pagination:  763-72     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 Elsevier Ltd. All rights reserved.
Division of Cardiology, University Hospital, Basel, Switzerland.
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MeSH Terms
Angina Pectoris / classification,  therapy
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Coronary Angiography
Coronary Artery Disease / diagnosis,  drug therapy,  physiopathology,  therapy*
Myocardial Infarction / complications,  mortality,  therapy*
Randomized Controlled Trials as Topic
Risk Assessment
Severity of Illness Index

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