[Revascularization in Stable Ischemic Heart Disease: Whether to Change the Approach?]

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Current guidelines for stable ischemic heart disease (IHD) recommend coronary revascularization based on symptoms, anatomy, and stress test results.
• However, the evidence supporting these recommendations stems from older studies with different medical therapies and revascularization techniques.
• Many conclusions are derived from observational studies and subanalyses, limiting their methodological reliability.

Purpose of the Study:

• To critically analyze the evidence base for current coronary revascularization guidelines in stable IHD.
• To review contemporary optimal medical therapy (OMT) components for stable IHD.
• To discuss the necessity of large-scale randomized clinical trials comparing OMT versus OMT plus revascularization.

Main Methods:

• Systematic review of existing literature and guidelines on stable IHD.
• Analysis of data from historical and recent clinical trials.
• Evaluation of contemporary OMT strategies.

Main Results:

• Evidence supporting current revascularization guidelines is largely based on outdated data and methodologically limited studies.
• Recent trials show conflicting results compared to older studies.
• Contradictory opinions exist within the cardiology community regarding revascularization indications.

Conclusions:

• The evidence base for current stable IHD revascularization guidelines requires re-evaluation due to outdated data and methodological limitations.
• There is a pressing need for large-scale randomized clinical trials to compare OMT with OMT plus revascularization in stable IHD patients.