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Revascularization versus medical treatments in stable coronary artery disease: Predicting the future of novel drug therapies for stable angina.
MedLine Citation:
PMID:  24336013     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
: Over the past two decades, drug therapy of patients with stable angina pectoris has improved, with a marked impact on the hard clinical outcomes of mortality and myocardial infarction. In contrast, recent trials have not demonstrated beneficial effects of revascularization on mortality. However, in the large trials that compared medical treatment with percutaneous coronary intervention (PCI) or surgery, high-risk patients, such as those with severe 3-vessel disease with or without left ventricular dysfunction, were excluded. In the COURAGE and FAME 2 trials, the only difference between the PCI and medical therapy groups was a higher rate of revascularization in the latter. Similar findings were made in studies comparing medical treatment with coronary surgery. New pharmacological approaches are being developed to further delay the progression of atherosclerosis. These include new lipid lowering drugs acting in concert with statins (cholesteryl ester transfer protein inhibitors, PCSK9 inhibitors), aldosterone antagonists, colchicine, methotrexate and IL-1 inhibitors. In conclusion, from the available data, PCI and coronary surgery have not been shown to improve hard end-points and routine use of invasive revascularization should be avoided in patients with chronic stable angina. Evidence-based secondary prevention remains the most important approach.
Authors:
Lamprini Risos; Guy Berkenboom
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-12-10
Journal Detail:
Title:  Journal of cardiovascular pharmacology     Volume:  -     ISSN:  1533-4023     ISO Abbreviation:  J. Cardiovasc. Pharmacol.     Publication Date:  2013 Dec 
Date Detail:
Created Date:  2013-12-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7902492     Medline TA:  J Cardiovasc Pharmacol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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