Therapeutic goals in patients with refractory angina

Mauricio G Cohen, E. Magnus Ohman

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Refractory angina is a major clinical challenge in-contemporary cardiovascular medicine. As therapeutic strategies evolve, there is increased life expectancy for ischemic heart disease with more patients reaching advanced stages. Due to a better understanding of the disease process and technological advances, coronary revascularization, by means of coronary by-pass grafting (CABG) and percutaneous coronary interventions (PCI), is now offered to a wide spectrum of high-risk patients. The inception of drug eluting stents in routine clinical practice has reduced the restenosis rates to single digits [1, 2], extending the indications of PCI to poor operative candidates with unprotected left main stenosis or diabetics with diffuse small vessel disease. In a similar fashion, more generalized use of major surgical revascularization breakthroughs, such as off-pump CABG and arterial grafts, have resulted in significant improvements in surgical outcomes [3]. Despite these advances, a significant proportion of patients with preserved left ventricular fraction and no life-threatening arrhythmias remain symptomatic with severe debilitating angina due to progression of native atherosclerotic disease associated with failure or unfeasibility of revascularization. In a prospective observational study, Hemingway et al. showed that at 1-year follow-up angina persists in 52% of patients treated with PCI and 40% of those treated with CABG [4]. Similar findings were observed in the multicenter international ARTS randomized trial, in which only 19% of PCI patients and 38% of CABG patients were free of angina and antianginal therapy at 1-year follow-up [5]. Moreover, in a meta-analysis of 11 randomized trials comparing PCI with medical therapy in stable patients with chronic coronary artery disease, PCI offered no survival benefit [6].

Original languageEnglish (US)
Title of host publicationCoronary Artery Disease: New Approaches without Traditional Revascularization
PublisherSpringer-Verlag London Ltd
Pages29-37
Number of pages9
Volume9781846287121
ISBN (Print)9781846287121, 1846284600, 9781846284601
DOIs
StatePublished - Apr 1 2014

Fingerprint

Percutaneous Coronary Intervention
Therapeutics
Drug-Eluting Stents
Life Expectancy
Observational Studies
Myocardial Ischemia
Meta-Analysis
Cardiac Arrhythmias
Coronary Artery Disease
Pathologic Constriction
Medicine
Prospective Studies
Transplants
Survival

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cohen, M. G., & Ohman, E. M. (2014). Therapeutic goals in patients with refractory angina. In Coronary Artery Disease: New Approaches without Traditional Revascularization (Vol. 9781846287121, pp. 29-37). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-84628-712-1_4

Therapeutic goals in patients with refractory angina. / Cohen, Mauricio G; Ohman, E. Magnus.

Coronary Artery Disease: New Approaches without Traditional Revascularization. Vol. 9781846287121 Springer-Verlag London Ltd, 2014. p. 29-37.

Research output: Chapter in Book/Report/Conference proceedingChapter

Cohen, MG & Ohman, EM 2014, Therapeutic goals in patients with refractory angina. in Coronary Artery Disease: New Approaches without Traditional Revascularization. vol. 9781846287121, Springer-Verlag London Ltd, pp. 29-37. https://doi.org/10.1007/978-1-84628-712-1_4
Cohen MG, Ohman EM. Therapeutic goals in patients with refractory angina. In Coronary Artery Disease: New Approaches without Traditional Revascularization. Vol. 9781846287121. Springer-Verlag London Ltd. 2014. p. 29-37 https://doi.org/10.1007/978-1-84628-712-1_4
Cohen, Mauricio G ; Ohman, E. Magnus. / Therapeutic goals in patients with refractory angina. Coronary Artery Disease: New Approaches without Traditional Revascularization. Vol. 9781846287121 Springer-Verlag London Ltd, 2014. pp. 29-37
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