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Chronic stable angina pectoris. Strategies for effective drug therapy
1Cardiology Section, University of Oklahoma College of Medicine, Oklahoma City 73104, USA.
Insights
Stable angina pectoris is often caused by severe coronary artery narrowing. Risk stratification and targeted treatments, including surgery for high-risk patients, improve outcomes for coronary artery disease.
Area of Science:
- Cardiology
- Vascular Medicine
- Internal Medicine
Background:
- Stable angina pectoris commonly results from eccentric atherosclerotic narrowing of coronary arteries, leading to chest pain and myocardial ischemia.
- Plaque rupture is a frequent cause of myocardial infarction or death in these patients.
- A subset of patients (10-20%) with stable angina exhibit normal coronary arteries and have an excellent long-term prognosis.
Purpose of the Study:
- To review the pathophysiology, prognosis, and management strategies for stable angina pectoris.
- To outline risk stratification methods for patients with coronary artery disease.
- To guide treatment decisions, including medical therapy, angioplasty, and coronary bypass surgery.
Main Methods:
- Review of existing literature on stable angina pectoris, focusing on etiology, risk factors, and treatment outcomes.
- Analysis of prognostic indicators such as left ventricular function and extent of coronary artery disease.
- Stratification of patients into low- and high-risk categories based on clinical presentation and diagnostic testing.
Main Results:
- Annual mortality in patients with atherosclerotic angina ranges from 1.6% to 3.2%, influenced by left ventricular function and disease extent.
- Risk stratification using medical history, resting left ventricular function, physical examination, and stress testing aids in identifying high-risk individuals.
- Coronary angiography is recommended for high-risk patients.
Conclusions:
- Risk-factor modification and antianginal drugs are effective for most patients.
- Angioplasty or coronary bypass surgery should be considered for patients unresponsive to medical management.
- Coronary bypass surgery is particularly indicated for patients with left main coronary artery disease, three-vessel disease, and impaired left ventricular function.
Abstract:
In most patients with stable angina pectoris, severe eccentric atherosclerotic narrowing of coronary arteries is responsible for chest pain and myocardial ischemia. If myocardial infarction or death occurs, it is usually the consequence of a ruptured plaque. About 10% to 20% of patients with stable angina have normal coronary arteries, and their long-term prognosis is excellent. In patients with angina secondary to atherosclerotic lesions, the annual mortality rate is 1.6% to 3.2%; prognosis is determined by systolic left ventricular function and the extent of coronary artery disease. Patients can be stratified into low- and high-risk groups by medical history, left ventricular function at rest, and results of physical examination and stress testing. Coronary angiography should be reserved for high-risk patients. Risk-factor modification and appropriate use of antianginal drugs are successful in most patients, but those who fail to respond should be considered for angioplasty or coronary bypass surgery; patients with left main coronary artery disease or three-vessel disease and poor left ventricular function should be considered for coronary artery bypass surgery.