[Treatment of stable angina pectoris: when to operate?]

Area of Science:

• Cardiology
• Cardiovascular Surgery

Background:

• Stable angina treatment involves medical or surgical options.
• Key factors influencing prognosis include coronary narrowing severity, collateral circulation, myocardium at risk, left ventricular function, and arrhythmias.

Purpose of the Study:

• To discuss diagnostic criteria for identifying coronary artery disease (CAD) patients at high risk for myocardial infarction or sudden death.
• To delineate patient groups who benefit from coronary bypass surgery.

Main Methods:

• Review of natural history of ischemic heart disease.
• Analysis of medical and surgical treatment possibilities.
• Discussion of diagnostic criteria for risk stratification.

Main Results:

• Two main groups benefit from coronary bypass surgery: those with refractory angina pectoris and those with left main or triple vessel disease, especially with impaired left ventricular function.
• Surgery for one- or two-vessel disease is indicated only when proximal narrowing affects a large myocardial area.

Conclusions:

• Risk stratification is crucial for guiding treatment decisions in stable angina.
• Coronary bypass surgery is indicated for specific high-risk CAD patient subsets.
• Percutaneous transluminal coronary angioplasty presents an alternative with its own set of possibilities and limitations.