[Evidence-based optimal treatment strategy of patients with angina pectoris]

The author summarizes the evidences of angina pectoris' optimal treatment. The invasive treatment strategy became a frontrunner in this field as well. During the last years the number of percutaneous interventions became higher than bypass operations in many countries as well as in Hungary. The place of percutaneous interventions and bypass surgery in the treatment of angina pectoris is an important clinical problem. The author summarizes the data of three possible treatment options (medical therapy, percutaneous interventions and bypass surgery) of angina pectoris based on data of randomised trials. The evidences show that the first steps of therapy are - after the diagnosis - the influence of risk factors, life-style changes and optimal medical therapy. The optimal medical therapy consists of statin, aspirin and ACE inhibitor treatment besides antianginal therapy, where the beta blockers are regarded as first drugs of choice. Percutaneous interventions as initial treatment option are not recommended because we have no evidences that this intervention prolongs life and prevents myocardial infarction. If the patient remains symptomatic after medical treatment, it is necessary to perform revascularization. These procedures can improve the functional capacity more than medical treatment alone. The optimal treatment strategy of angina pectoris, based on evidence, is an important medical and economical problem.