Evaluation of the stable coronary artery disease patient: Anatomy trumps physiology

Desai, Karan; Sidhu, Mandeep S.; Boden, William E.

doi:10.1016/j.tcm.2014.08.003

Cited by 4 publications

(1 citation statement)

References 35 publications

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“…Furthermore, in a BARI 2D nuclear substudy, the extent of ischemia on stress MPI 1 year after randomization was not predictive of subsequent mortality in patients on OMT, concordant with the 2014 COURAGE trial posthoc analysis [46]. Despite the typical emphasis given to identifying tangible evidence of inducible ischemia on noninvasive testing, the evidence to date based on the above posthoc analyses, weighs against the presence of demonstrable ischemia being able to identify a cohort of SIHD patients who would benefit from initial revascularization [47].…”

Section: What Is More Important In Sihd the Atherosclerotic Burden Omentioning

confidence: 58%

Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when to revascularize

et al. 2015

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Patients with acute coronary syndromes and severe multivessel or left main coronary artery disease have better outcomes when prompt revascularization is performed in addition to optimal medical therapy (OMT). However, in patients with stable ischemic heart disease, randomized strategy trials have revealed equipoise between initial strategies of OMT alone and OMT plus revascularization. Conducted in diverse stable ischemic heart disease patient populations and throughout the spectrum of atherosclerotic and ischemic burden, the RITA-2, MASS II, COURAGE, BARI 2D and FAME 2 trials demonstrate that OMT alone and OMT plus revascularization yield similar outcomes with respect to mortality and myocardial infarction. What remains unclear is whether there may be one or more subsets of patients with stable ischemic heart disease in whom revascularization may be associated with a reduction in mortality or myocardial infarction, which is to be addressed in the ongoing ISCHEMIA trial.

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Section: What Is More Important In Sihd the Atherosclerotic Burden Omentioning

confidence: 58%

Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when to revascularize

et al. 2015

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Optimal Management of Multivessel CAD: PCI Versus CABG Surgery Versus Medical Therapy Alone

Boden

2015

Controversies in Cardiology

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Conservative Versus Invasive Stable Ischemic Heart Disease Management Strategies: What do We Plan to Learn From the ISCHEMIA trial?

et al. 2015

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Over the past decade, landmark randomized clinical trials comparing initial management strategies in stable ischemic heart disease (SIHD) have demonstrated no significant reduction in 'hard' end points (all-cause mortality, cardiac death or myocardial infarction) with one strategy versus another. The main advantage derived from early revascularization is improved short-term quality of life. Nonetheless, questions remain regarding how best to manage SIHD patients, such as whether a high-risk subgroup can be identified that may experience a survival or myocardial infarction benefit from early revascularization, and if not, when should diagnostic catheterization and revascularization be performed. The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches trial is designed to address these questions by randomizing SIHD patients with at least moderate ischemia to an initial conservative strategy of optimal medical therapy or an initial invasive strategy of optimal medical therapy plus cardiac catheterization and revascularization.

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Evaluation of the stable coronary artery disease patient: Anatomy trumps physiology

Cited by 4 publications

References 35 publications

Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when to revascularize

Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when to revascularize

Optimal Management of Multivessel CAD: PCI Versus CABG Surgery Versus Medical Therapy Alone

Conservative Versus Invasive Stable Ischemic Heart Disease Management Strategies: What do We Plan to Learn From the ISCHEMIA trial?

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