Initial strategy of revascularization versus optimal medical therapy for improving outcomes in ischemic heart disease: a review of the literature.

Current Cardiology Reports
A Vincent Songco, Sorin J Brener

Abstract

Defining optimal management of patients with stable coronary artery disease continues to be a central area of debate. While it has been established that all patients with coronary artery disease should at least be managed with optimal medical therapy, many patients with stable coronary artery disease continue to be treated with revascularization, whether by percutaneous coronary intervention or coronary artery bypass grafting. What remains unclear is whether revascularization further improves outcomes when added to medical therapy. We start by reviewing trials that define optimal medical therapy. We then review results of randomized trials comparing both revascularization strategies with optimal medical therapy and assess the strengths and limitations of each. Next, we briefly describe the ongoing ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial, which will seek to determine optimal management for patients with stable ischemic heart disease in a population of patients at a uniformly higher risk prior to diagnostic cardiac catheterization. We conclude that revascularization and medical therapy should be used as complementary strategies. Available data have shown some b...Continue Reading

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Citations

Mar 5, 2016·Evidence-based Complementary and Alternative Medicine : ECAM·Shiao DingJu Mei
Feb 22, 2016·EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology·Jane A SimonsenPoul F Høilund-Carlsen
Mar 15, 2013·Journal of the American College of Radiology : JACR·Brian B GhoshhajraUdo Hoffmann
May 23, 2013·International Journal of Molecular Medicine·Xian-Yue WangWei-Da Zhang
Feb 13, 2018·Journal of Cardiovascular Medicine·Mauro BorziFrancesco Romeo
Jun 27, 2012·Nature Reviews. Cardiology·Yuli HuangYanxian Wu

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