Controversies in cardiovascular medicine: Chronic stable coronary artery disease: drugs vs. revascularization

Simoons, Maarten L; Windecker, Stephan (2010). Controversies in cardiovascular medicine: Chronic stable coronary artery disease: drugs vs. revascularization. European Heart Journal, 31(5), pp. 530-41. Oxford: Oxford University Press 10.1093/eurheartj/ehp605

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Coronary artery disease remains the leading cause of mortality in most industrialized countries, although age-standardized mortality related to coronary artery disease (CAD) has decreased by more than 40% during the last two decades. Coronary atherosclerosis may cause angina pectoris, myocardial infarction, heart failure, arrhythmia, and sudden death. Medical management of atherosclerosis and its manifestation aims at retardation of progression of plaque formation, prevention of plaque rupture, and subsequent events and treatment of symptoms, when these occur as well as treatment of the sequelae of the disease. Revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) is performed as treatment of flow-limiting coronary stenosis to reduce myocardial ischaemia. In high-risk patients with acute coronary syndromes (ACS), a routine invasive strategy with revascularization in most patients provides the best outcome with a significant reduction in death and myocardial infarction compared with an initial conservative strategy. Conversely, the benefit of revascularization among patients with chronic stable CAD has been called into question. This review will provide information that revascularization exerts favourable effects on symptoms, quality of life, exercise capacity, and survival, particularly in those with extensive CAD and documented moderate-to-severe ischaemia. Accordingly, CABG and PCI should be considered a valuable adjunct rather than an alternative to medical therapy.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan

ISSN:

0195-668X

Publisher:

Oxford University Press

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:10

Last Modified:

31 Oct 2019 07:26

Publisher DOI:

10.1093/eurheartj/ehp605

PubMed ID:

20106842

Web of Science ID:

000275241900010

BORIS DOI:

10.7892/boris.1637

URI:

https://boris.unibe.ch/id/eprint/1637 (FactScience: 203415)

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