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The management of stable angina
M Petticrew1, M Turner-Boutle, T Sheldon
1NHS Centre for Reviews and Dissemination, York University, UK.
Insights
Medical treatments are effective for less severe angina, while invasive procedures like CABG are better for higher-risk patients. Long-term aspirin and cholesterol therapy improve outcomes after invasive procedures.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Services Research
Background:
- Chronic stable angina symptoms signal increased risk of heart attack and death.
- Current treatment strategies vary in effectiveness based on patient risk stratification.
Purpose of the Study:
- To evaluate the comparative effectiveness of medical versus invasive treatments for chronic stable angina.
- To assess the role of adjunctive therapies and identify needs for evidence-based guidance and equitable access.
Main Methods:
- Review of existing evidence on medical treatments (pharmacotherapy) for angina.
- Analysis of outcomes for invasive revascularisation procedures, including coronary artery bypass grafting (CABG) and angioplasty.
- Evaluation of adjunctive therapies like aspirin and cholesterol-lowering medication.
Main Results:
- Medical treatments are as effective as invasive options for less severe angina, with better survival rates.
- Coronary artery bypass grafting (CABG) shows slightly better efficacy than angioplasty, which often requires re-treatment.
- Long-term low-dose aspirin and cholesterol-lowering therapy reduce recurrence and coronary events post-intervention.
- No clear cost-effectiveness advantage for intracoronary stents over standard angioplasty.
Conclusions:
- Treatment decisions for chronic stable angina should be risk-stratified, favoring medical management for lower-risk patients and revascularisation for higher-risk individuals.
- Adjunctive long-term therapies are crucial for improving outcomes after invasive procedures.
- Evidence-based guidance is needed for referral thresholds, and disparities in access to care based on gender, ethnicity, and social class require monitoring and intervention to promote equity.
Abstract:
Symptoms of chronic stable angina are easily identifiable and indicate that a patient is at increased risk of heart attack and death. In patients with less severe angina, medical treatments are as effective as more invasive treatments and produce better survival rates. There is little evidence that the main types of medical treatment differ in effectiveness. For patients at higher risk, invasive revascularisation procedures--coronary artery bypass grafting (CABG) and angioplasty--are more appropriate. CABG is slightly more effective than angioplasty. A high proportion of patients receiving angioplasty require re-treatment. The risk of recurrence and coronary events is reduced if patients who receive invasive procedures also have long-term low dose aspirin and cholesterol-lowering therapy. There is no clear evidence that intracoronary stents are more cost-effective than standard angioplasty. There is a need for evidence-based guidance to help determine referral thresholds for further investigation, and revascularisation procedures. There is evidence of inequality of access to testing and treatment, by gender, ethnic group and social class. Access should be monitored in order to promote equity.