[Stable angina pectoris deserves better treatment]

Area of Science:

• Cardiology
• Public Health
• Health Economics

Background:

• Coronary artery disease (CAD) poses a significant health burden in the Netherlands, with annual healthcare costs around 2.3 billion.
• Cardiovascular risk management (CVRM) is proven to reduce mortality and prevent myocardial infarction in patients with stable angina pectoris (AP).

Purpose of the Study:

• To evaluate the efficacy of percutaneous coronary intervention (PCI) in stable AP patients without left main coronary artery stenosis or heart failure.
• To outline an improved treatment strategy for stable AP, emphasizing integrated care and optimal medical therapy.

Main Methods:

• Analysis of treatment outcomes for stable AP patients undergoing PCI versus conservative management.
• Review of current guidelines and proposed models for interdisciplinary collaboration between general practitioners and cardiologists.

Main Results:

• PCI does not reduce mortality or prevent myocardial infarction in stable AP patients lacking left main coronary artery stenosis or heart failure.
• The impact of PCI on angina symptoms in this patient group remains uncertain.

Conclusions:

• Optimal treatment for stable AP involves intensive CVRM and targeted anti-anginal medication, with PCI considered only when optimal medical therapy (OMT) is insufficient.
• Effective management necessitates clear communication, shared tasks between general practitioners and cardiologists via network medicine, and standardized multidisciplinary guidelines and quality indicators.
• Healthcare financing models should support this integrated approach to stable AP treatment.