Revascularization or optimal medical therapy in stable coronary artery disease. Which strategy to follow?
Szegedi Tudományegyetem, Általános Orvostudományi Kar, Családorvosi Intézet, Szeged
Defining optimal management of patients with stable, ischemic heart disease is still a central area of debate. All patients with coronary artery disease should at least be managed with optimal medical therapy, many patients with stable coronary artery disease continue to be treated with revascularization, whether by percutaneous coronary intervention or coronary artery bypass grafting. It remains unclear is whether revascularization further improves prognosis when added to optimal medical therapy. In the present summary we start by reviewing the definition and details of optimal medical therapy and then to review the results of randomized trials comparing both revascularization strategies with optimal medical therapy. We conclude that revascularization and medical therapy should be used as complementary strategies. Which strategy to follow? Hopefully the ongoing ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial will bring us closer to the answer which seeks to determine optimal management for patients with stable ischemic heart disease.