Stable ischemic heart disease: Indications for revascularization
- Thomas Levin, MD
Thomas Levin, MD
- Illinois Heart and Vascular
- Chicago, Illinois
- Julian M Aroesty, MD
Julian M Aroesty, MD
- Clinical Associate Professor of Medicine
- Harvard Medical School
The goals of therapy in patients with stable ischemic heart disease, which includes individuals with severe symptoms to those who are asymptomatic, are to alleviate symptoms, delay or prevent the progression of coronary artery disease, and decrease the risk of adverse outcomes such as death, heart failure, or myocardial infarction. To this end, all patients should receive optimal medical therapy. Revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is reserved for:
●Patients with unacceptable angina
●Patients likely to have a survival benefit from revascularization, based upon the location and severity of the lesion, the number of diseased vessels, and the presence of left ventricular dysfunction.
The efficacy of medical therapy compared to revascularization in patients with stable ischemic heart disease will be reviewed here. The choice between PCI and CABG when revascularization is required is discussed separately. (See "Revascularization in patients with stable coronary artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention".)
The role of revascularization in patients with acute coronary syndromes (myocardial infarction and unstable angina) is discussed elsewhere. (See "Overview of the acute management of ST elevation myocardial infarction", section on 'Reperfusion' and "Overview of the acute management of non-ST elevation acute coronary syndromes", section on 'Immediate angiography and revascularization'.)
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- OUR APPROACH
- OPTIMAL MEDICAL THERAPY
- INDICATIONS FOR NONINVASIVE TESTING
- INDICATIONS FOR CORONARY ANGIOGRAPHY
- INDICATIONS FOR CABG
- Improvement in survival
- Relief of angina
- INDICATIONS FOR PCI
- Improvement in survival
- Relief of angina
- PATIENTS WITHOUT CLEAR INDICATIONS
- Patient preference
- Severity of coronary artery disease
- Reduced left ventricular systolic function
- CABG VERSUS PCI
- Patients with diabetes
- RECOMMENDATIONS OF OTHERS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS