[Management of the patient with chronic coronary artery disease]

All patients with suspected angina need rapidly further cardiological examinations to check the diagnosis and fix the prognosis (at least clinical and risk factor evaluations and a resting ECG). The initial non-invasive strategy should include an echocardiography and a stress test (exercise ECG, stress echocardiography or perfusion scintigraphy), followed, in the majority of cases, by a coronary angiography. Lifestyle changes are mandatory and are fully part of secondary prevention: cigarette smoking withdrawal, mediterranean diet (fruit, vegetables, fish and poultry), weight loss, moderate alcohol consumption, increased omega-3 fatty acids and regular physical activity. Pharmacological therapy of stable coronary artery disease should associate short-acting nitrates (in case of angina), and systematically aspirin and statin. A beta-blocker should be used as a first-line therapy, particularly in the post-infarction setting or in case of left ventricular dysfunction. In case of contraindication, a calcium inhibitor or a long-acting nitrate should be choosen. ACE inhibitors are indicated in patients with left ventricular dysfunction, hypertension or diabetes and should also be considered in high-risk patients. The combination aspirin plus clopidogrel is required for at least one month after insertion of a nude stent, 12 months after an active stent or an acute coronary syndrome.