Authors: Lawrence M Phillips Rory Hachamovitch Daniel S Berman Ami E Iskandrian James K Min Michael H Picard Raymond Y Kwong Matthias G Friedrich Marielle ScherrerCrosbie Sean W Hayes Tali Sharir Gilbert Gosselin Marco Mazzanti Roxy Senior Rob Beanlands Paola Smanio Abhi Goyal Mouaz AlMallah Harmony Reynolds Gregg W Stone David J Maron Leslee J Shaw
Publish Date: 2013/08/21
Volume: 20, Issue: 6, Pages: 969-975
Abstract
There is a preponderance of evidence that in the setting of an acute coronary syndrome an invasive approach using coronary revascularization has a morbidity and mortality benefit However recent stable ischemic heart disease SIHD randomized clinical trials testing whether the addition of coronary revascularization to guidelinedirected medical therapy GDMT reduces death or major cardiovascular events have been negative Based on the evidence from these trials the primary role of GDMT as a front line medical management approach has been clearly defined in the recent SIHD clinical practice guideline the role of prompt revascularization is less precisely defined Based on data from observational studies it has been hypothesized that there is a level of ischemia above which a revascularization strategy might result in benefit regarding cardiovascular events However eligibility for recent negative trials in SIHD has mandated at most minimal standards for ischemia An ongoing randomized trial evaluating the effectiveness of randomization of patients to coronary angiography and revascularization as compared to no coronary angiography and GDMT in patients with moderatesevere ischemia will formally test this hypothesis The current review will highlight the available evidence including a review of the published and ongoing SIHD trials
Keywords: