PCI compared with medical therapy in elderly patients with chronic symptomatic coronary artery disease

Objective The aim of this study was to assess quality of results of elderly patients with coronary disease after medical or revascularisation therapy. Methods In this study, we enrolled 103 patients aged 75 years or older with chronic angina in which 47 patients were assigned coronary angiography and revascularisation and 56 patients with optimised medical therapy. The primary endpoint was quality of life after 6 months, as assessed by questionnaire and the presence of major adverse cardiac events (death, non fatal myocardial infarction, or hospital admission for acute coronary syndrome with or without the need for revascularisation). Results After 6 months follow up, angina severity decreased and measures of quality of life increased in both treatment groups( P <0.05 ); however, these improvements were significantly greater after revascularisation( P <0.01 ). Major adverse cardiac events occurred in 30 ( 53.6% ) of patients in the medical group and 9 ( 19.1% ) in the invasive group ( P <0.01 ).Conclusions Patients aged 75 years or older with angina benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk profile followed by revascularisation if feasible.

Atrial fibrillation and coronary artery disease:An integrative review focusing on therapeutic implications of this relationship

The incidence of both atrial fibrillation(AF)and coronary artery disease(CAD)increases with advancing age.They share common risk factors and very often coexist.Evidence points to an intricate relationship between atrial tissue excitability and neuronal remodeling with ischemia at the microcirculatory level.In this review,we delineated this complex relationship,identified a common theme between the two,and discussed how the knowledge of this relationship translates into a positive and meaningful impact in patient management.Recent research indicates a high prevalence of CAD among AF patients undergoing coronary angiography.Further,the incidence of AF is much higher in those suffering from CAD compared to age-matched adults without CAD underlying this reciprocal relationship.CAD adversely affects AF by promoting progression via re-entry and increasing excitability of atrial tissue as a result of ischemia and electrical inhomogeneity.AF in turn accelerates atherosclerosis via endothelial dysfunctional and inflammation and together with enhanced thrombogenicity and hypercoagulability contribute to micro and macrothrombi throughout cardiovascular system.In a nutshell,the two form a vicious cycle wherein one disease promotes the other.Most AF recommendations focuses on rate/rhythm control and prevention of thromboembolism.Very few studies have discussed the importance of unmasking coexistent CAD and how the treatment of underlying ischemia will impact the burden of AF in these patients.Inflammation and endothelial dysfunction remain central to both disease processes and form a handsome therapeutic target in the management of the two diseases.The relationship between AF and CAD is complex and much more than mere coincidence.The two diseases share common risk factor and pathophysiology.Hence,it is impractical to treat them in isolation.Accordingly,we share the implications of managing underlying ischemia and inflammation to positively impact and improve quality of life among AF patients.

Optimization of the pharmacological therapy in patients with polyvascular disease: A multidisciplinary approach

The recent shift of the concept of cardiovascular disease as a chronic progressive condition,potentially involving multiple districts,has driven attention to the optimal management of patients with concomitant coronary and peripheral artery disease,representing a subset of patients with an increased risk of events and impaired survival.Recent pharmacological achievements in terms of antithrombotic therapy and lipid-lowering drugs allow multiple therapeutical combinations,thus requiring optimizing the treatment in a tailored fashion according to patients’risk profiles.Nevertheless,data dedicated to this specific subset of patients are still modest.We summarize currently available strategies and indications for the management of antithrombotic and lipid-lowering drugs in patients with the poly-vascular disease.

Effectiveness of cognitive behavioral therapy-based interventions on health outcomes in patients with coronary heart disease:A metaanalysis

BACKGROUND Recently,the efficacy of cognitive behavioral therapy(CBT)-based intervention on health outcomes in patients with coronary heart disease(CHD)has been recognized in randomized controlled trials(RCTs),but no comprehensive systematic review has been conducted.To address this research gap,our study aimed to evaluate whether comprehensive CBT-based interventions positively affect health outcomes in CHD patients.It was hypothesized that CBT-based interventions are effective in:(1)Reducing depression,anxiety,and stress symptoms;(2)Reducing body mass index,blood pressure,and lipid levels;and(3)Improving quality of life,and exercise endurance.AIM To verify the effectiveness of CBT-based interventions on CHD patients through a meta-analysis of previous publications.METHODS Relevant RCTs published in English were obtained by searching electronic databases,including PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and Proquest,with the retrieval time from inception to August 2020.The primary outcomes were psychological factors(depression,anxiety,and stress symptoms),physiological factors(body mass index,blood pressure,blood lipids).The secondary outcomes included quality of life and exercise endurance.We used Review Manager 5.3 to conduct the meta-analysis and used the Physiotherapy Evidence Database tool to evaluate the quality of studies.RESULTS A total of 22 RCTs comprising 4991 patients with CHD were included in the systematic review and meta-analysis.The main analysis revealed that CBT-based intervention can reduce depression symptoms:-2.00[95%confidence interval(CI):-2.83 to-1.16,P<0.001];anxiety symptoms:-2.07(95%CI:-3.39 to-0.75,P=0.002);stress symptoms:-3.33(95%CI:-4.23 to-2.44,P<0.001);body mass index:-0.47(95%CI:-0.81 to-0.13,P=0.006);and improve physical functioning:3.36(95%CI:1.63 to 5.10,P=0.000)and mental functioning:6.91(95%CI:4.10 to 9.73,P<0.001).Moreover,subgroup analysis results showed that CBT-based interventions were more effective for symptoms of depression and anxiety in CHD patients when individual,as opposed to group treatment,and psycho-education,behavioral and cognitive strategies were applied as the core treatment approaches.CONCLUSION CBT-based interventions are effective treatment strategies for CHD patients,significantly improving their symptoms of depression,anxiety and stress,body mass index,and health-related quality of life.

Safety and efficacy of dual antiplatelet therapy after percutaneous coronary interventions in patients with end-stage liver disease

The prevalence of coronary artery disease(CAD)increases in patients with endstage liver disease,with part of them receiving the percutaneous coronary intervention(PCI)as a treatment option.Dual antiplatelet therapy(DAPT),a standard of care after PCI,could result in catastrophic consequences in this population.Before PCI and the start of DAPT,it is recommended to assess patient bleeding risk.Based on novel findings,liver cirrhosis does not necessarily lead to a significant increase in bleeding complications.Furthermore,conventional methods,such as the international normalized ratio,might not be appropriate in assessing individual bleeding risk.The highest bleeding risk among cirrhotic patients has a subgroup with severe thrombocytopenia(<50×10^(9)/L)and elevated portal pressure.Therefore,every effort should be made to maintain thrombocyte count above>50×10^(9)/L and prevent variceal bleeding.There is no solid evidence for DAPT in patients with cirrhosis.However,randomized trials investigating short(one month)DAPT duration after PCI with new drug-eluting stents(DES)in a high bleeding risk patient population can be implemented in patients with cirrhosis.Based on retrospective studies(with older stents and protocols),PCI and DAPT appear to be safe but with a higher risk of bleeding complications with longer DAPT usage.Finally,novel methods in assessing CAD severity should be performed to avoid unnecessary PCI and potential risks associated with DAPT.When indicated,PCI should be performed over radial artery using contemporary DES.Complementary medical therapy,such as proton pump inhibitors and beta-blockers,should be prescribed for lower bleeding risk patients.Novel approaches,such as thromboelastography and“preventive”upper endoscopies in PCI circumstances,warn clinical confirmation.

The impact of optimal medical therapy at discharge on mortality in patients with coronary artery disease

最佳的医药治疗(OMT ) 的当前的用法，影响因素，和为在有不同 subgroups.MethodsA 的病人 3176 个 CAD 病人总计的冠的动脉疾病(CAD ) 的所有原因死亡的 OMT 的预兆的值由冠的 angiography 证实了的 ObjectiveTo 分析被包括。OMT 被定义为变换酶禁止者或血管收缩素受体 blockers 的反血小板药， statins，贝它 blockers，和血管收缩素的联合。为 OMT 和它的预示的价值的因素越过 3176 个病人的不同 subgroups.ResultsOut 在 CAD 病人被分析，仅仅 39.8%(n = 1265 ) 在在分泌物的 OMT 上。在分泌物与 OMT 联系的因素是承认前 OMT 和分泌物部门。所有原因死亡发生在 6.8%(n = 217 ) 病人。Multivariate 分析显示 OMT 显著地与减少的所有原因死亡被联系(HR：0.65， 95% CI：0.45-0.95；P = 0.025 ) 。亚群分析显示男急性冠的症候群(交流) 病人是更可能的在分泌物与 OMT 收到幸存好处。在分泌物的 OMT 的积极影响在 24 个月以后是更明显的，不管 revascularization 治疗。OMT 的四药的联合比在交流病人的 3 药联合治疗优异然而并非在马厩， patients.ConclusionsOMT 与 CAD 在病人在幸存与重要改进被联系。OMT 的积极影响在有不同特征的 CAD 病人是不同的。

Long-term outcomes of high-risk elderly male patients with multivessel coronary disease： optimal medical therapy versus revascularization

BackgroundMany 研究显示了那医药治疗和经皮的冠的干预与稳定的冠的动脉疾病以病人的长期的预后有类似的效果。这研究与高风险的 angina.MethodsIn 在老病人调查了最佳的医药治疗(OMT ) 和 revascularization-plus-OMT 的效果这未来的非使随机化的研究，有 angiographically 证实的 multivessel 疾病的 241 个连续高风险的老男病人(65-92 岁) 从 2004 年 1 月在登记被注册到 2005 年4月。这些， 98 个病人经历了 OMT ， 143 加后续的 OMT.ResultsAfter 6.5 年经历了 revascularization 治疗，我们发现长期的心脏的死亡的率在比在经历了 revascularization 的那些经历了 OMT 的病人是显著地更高的(6.5年的 unadjusted 死亡率，14.3%为 OMT 对7.0%为 revascularization 病人；木头等级 P = 0.04 ) 。然而，主要不利心脏的脑血管的事件(MACCE ) 的全面风险在所有病人之中是类似的(6.5 年的 unadjusted 死亡率， 29.6% 为 OMT 对 27.3% 为 revascularization 病人；木头等级 P = 0.67 ).ConclusionsOMT 与心脏的死亡的增加被联系但是 MACCE 的类似的 6.5 年的风险与在有冠的 multivessel 的高风险的老男病人的 revascularization 相比疾病。

The Effect of EDTA Chelation Therapy in Symptomatic Coronary Heart Disease: An Observational Study

Ethylene Diamine Tetra Acetic Acid (EDTA) chelation therapy has been considered a definitive alternative therapy for by-pass surgery in atherosclerotic cardiovascular disease for more than four decades. It is a relatively inexpensive method believed to restore blood flow in atherosclerotic vessels. However, the benefits of chelation therapy yet remain controversial in the treatment of ischemic heart disease. We observed the effect of EDTA chelation therapy on exercise tolerance in 13 volunteering patients receiving conventional treatment for established symptomatic coronary heart disease. Each patient received 30 weekly infusions of EDTA followed by monthly 12 boosters according to the ACAM protocol (American College for Advancement in Medicine). This was in addition to the conventional therapies they received from their respective physician in hospital. Stress ECG, echocardiography and coronary angiogram findings were obtained at the beginning of treatment. The distance that a patient could walk on level ground at moderate speed and the number of steps he/she can climb up on a staircase until he/she begins to feel either chest pain or breathlessness were the two clinical parameters of exercise tolerance recorded to grade angina. Liver and renal functions were tested at 1st, 5th, 10th, 15th and 30th infusions. Of the 13 patients, 11 showed improvement in angina grading whilst 2 experienced no effect. One patient improved from angina grade IV to I, 6 from grade III to I, 1 from grade III to II and 3 from grade II to I. A statistically significant reduction in the mean score (p = 0.002) was noticed at 6th month of treatment when compared to that of the first month. A significant 1.7 fold increase (p = 0.009) in the mean SGPT level was observed at the 30th infusion when compared to the pre-treatment values. The SGOT level showed no significant change (p = 0.664). None of the patients showed clinical features of hepato-cellular damage. The mean serum creatinine level showed a trend for reduction (p = 0.083) with treatment. The recognized side effects of intravenous EDTA chelation therapy such as liver damage, renal damage, hypersensitivity, symptomatic hypocalcaemia, and thrombophlebitis were not encountered. Thus, EDTA chelation therapy as prescribed by the ACAM protocol seems safe and effective in improving exercise tolerance in ischemic heart disease when administered concurrently with conventional therapy.

Effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy

Objective: To explore the effects of Ticagrelor on oxidative stress, coagulation function, platelet function and related factors in patients with coronary artery disease undergoing interventional therapy. Methods: A total of 140 patients with coronary artery disease who underwent percutaneous coronary intervention in our hospital from October 2016 to March 2018 were selected as the study subjects and were divided into control group (70 cases) and observation group (70 cases) by drawing lots. Both groups were treated with symptomatic routine therapy before operation. On this basis, the control group was treated with clopidogrel before operation, and the observation group was treated with Ticagrelor before operation on the basis of routine treatment. The changes of oxidative stress, coagulation index, platelet function and related factors were compared between the two groups before and after treatment. Results: Before treatment, there were no significant differences in oxidative stress factors, coagulation parameters, platelet parameters and related factors factors between the two groups. After treatment, the levels of MDA, MPAR, VEGF and MMP-9 in the two groups were lower than those before treatment, while the levels of SOD, APTT, TT and PT were higher than those before treatment;and the levels of MDA, MPAR, VEGF, MMP-9, APTT and PT in the observation group were significantly lower than those in the control group after treatment, while the levels fo SOD, TT and IPA in the observation group were significantly higher than those in the control group. Conclusions: Ticagrelor can better reduce oxidative stress injury, improve coagulation function and coronary stenosis, and inhibit platelet aggregation in patients with coronary heart disease undergoing PCI than clopidogrel. It has clinical popularization significance.

Application progress of cognitive behavioral therapy in coronary heart disease

To As one of the most common cardiovascular diseases,coronary heart disease has a high morbidity and mortality.In recent years,non-drug therapy has been put on equal importance with drug therapy due to its simple operation and fast onset.Cognitive behavioral therapy,as a kind of non-drug therapy,has been widely used to improve the physical and mental symptoms of patients with coronary heart disease.This article reviews the origin,concept,theoretical basis,characteristics,technology,and current research status of cognitive behavioral therapy in patients with coronary heart disease,in order to provide a reference for the clinical development of cognitive behavioral therapy.

Current status of high on-treatment platelet reactivity in patients with coronary or peripheral arterial disease:Mechanisms,evaluation and clinical implications

Antiplatelet therapy with aspirin or clopidogrel or both is the standard care for patients with proven coronary or peripheral arterial disease,especially those undergoing endovascular revascularization procedures. However,despite the administration of the antiplatelet regiments,some patients still experience recurrent cardiovascular ischemic events. So far,it is well documented by several studies that in vitro response of platelets may be extremely variable. Poor antiplatelet effect of clopidogrel or high on-treatment platelet reactivity(HTPR) is under investigation by numerous recent studies. This review article focuses on methods used for the ex vivo evaluation of HTPR,as well as on the possible underlying mechanisms and the clinical consequences of this entity. Alternative therapeutic options and future directions are also addressed.

Long-term effect of stenting in unprotected left main coronary artery disease in the elderly

To evaluate the feasibility, safety and efficacy of percutaneous stent implantation for treating left main coronary artery (LMCA) stenosis. Methods Consecutive patients with unprotected left main coronary artery disease treated by stent-based percutaneous intervention (PCI) at 6 medical centers in China were enrolled. Procedural data and clinical outcomes were obtained from all patients. Results From January 2001 to December 2004, 138 patients (79 males and 59 females; mean age: 69.7±5.8 years)underwent PCI for LMCA stenosis. Bare metal stents (BMS) were implanted in 51 patients with non-bifurcational lesions and in 5 patients with bifurcational lesions from January of 2001 to June of 2003 (BMS group);. Drug eluting stents (DES) were used unselectively to cover both bifurcational and non-bifurcational lesions in 86 patients from July of 2003 to December of 2004 (DES group). Procedural success rate of the 138 cases was 98% (135/138). One patient (0.7%) with bifurcation lesion who was treated with DES died from severe heart failure 2 weeks after the procedure. During a mean follow up period of 21.3 ± 5.6 months, one patient died from renal failure, one from sudden cardiac death, 4 underwent target lesion revascularization (TLR) in the BMS group, which all occurred in patients with bifurcational lesions; whereas in the DES group no deaths occurred and only one patient with bifurcational lesion had TLR. Conclusions (1) PCI is feasible and relatively safe to treat unprotected left main coronary artery disease in elderly patients at medical centers with experienced professionals. (2) BMS and DES have similar immediate and long-term efficacy in the treatment of ostium and shaft lesions of the LMCA. (3) DES are strongly suggested in the therapy of distal bifurcation lesion of unprotected LMCA.

Prevention of Coronary Heart Disease: A Translational Clinical Challenge

Introduction: Atherosclerotic cardiovascular disease is a dysmetabolic medical condition resulting in the #1 cause of morbidity and mortality in the United States. Coronary Artery Calcium (CAC) CT non-invasively identifies atherosclerosis in asymptomatic individuals. This translational study tested the hypothesis that clinically overtcardiovascular disease can be prevented in asymptomatic individuals in a medical clinic. Methods: Two hundred and six asymptomatic adults requested a CAC scan to identify subclinical heart disease. Individuals with a positive CAC score > 1 (n = 125) were prescribed targeted medical therapy to reverse their atherosclerosis. The goal was to achieve an LDL Cholesterol (LDL-C) ≤ 60 mg/dl. One hundred and ten individuals reached this goal (67 male, 43 female) receiving 10 mg/d of rosuvastatin and 10 mg/d of ezetimibe plus a low cholesterol diet. Other fifteen individuals with positive CAC scores did not achieve this LDL-C goal. Results: In the group following medical therapy and achieving an LDL-C ≤ 60 mg/dl, no cardiovascular events were observed during a maximum observation period of 5 years (mean observation time = 3.6 years). Based on previously published CVD outcome data in individuals with similar CAC scores, 12.6 cardiovascular events were expected. Two of fifteen individuals with positive CAC scores not following medical therapy had a cardiovascular event. None of the 81 individuals with a zero score had a cardiovascular event during follow-up. No adverse effects of therapy occurred. Conclusion: In a medical clinic, adult population with positive CAC scores and an LDL-C ≤ 60 mg/dl, targeted medical therapy prevented overt cardiovascular disease. These results should encourage other physicians to aggressively treat atherosclerotic cardiovascular disease in their clinic populations.

Clinical characteristics and one year outcomes in Chinese atrial fibrillation patients with stable coronary artery disease： a population-based study

然而， BackgroundAtrial 纤维性颤动(AF ) 和冠的动脉疾病(CAD ) 经常共存临床的特征和在有 AF 的中国病人的结果上的稳定的 CAD 的影响一直不好在到 2011 年 10 月的从 2008 年 11 月的中国的 20 所医院里的 understood.MethodsConsecutive AF 病人被注册。主要端点包括了 1 年的所有原因死亡，击，非中央的神经系统(non-CNS ) 栓塞，和 1947 个 AF 病人的主要 bleeding.ResultsA 总数被分析，谁 40.5% 有的稳定的 CAD。在 CAD 病人的吝啬的纸孔 2 分数比非 CAD 病人的显著地高(2.4 ±；1.4 对 1.4 ±；1.2， P <；0.001 ) 。在后续时期期间， warfarin 使用在两个组是低的，与在与 CAD 病人相比的非 CAD 病人的相对更高的比例(22.3% 对 10.7% ， P <；0.001 ) 。与非 CAD 病人相比， CAD 病人有更高的一个年所有原因死亡(16.8% 对 12.9% ， P = 0.017 ) 并且击的发生(9.0% 对 6.4% ， P = 0.030 ) ，当 non-CNS 栓塞和主要流血率在二个组之间是可比较的时。在 multivariate 调整以后，稳定的 CAD 独立地与 1 年的所有原因死亡的增加的风险被联系(HR = 1.35， 95% CI：1.01 −； 1 .80， P = 0.040 ) ，然而并非与击联系了(HR = 1.07， 95% CI：0.72-1.58， P = 0.736 ).ConclusionsStable CAD 在中国 AF 病人是流行的并且独立地与 1 年的所有原因的增加的风险被联系死亡。有稳定的 CAD 的中国 AF 病人收到了不适当的 antithrombotic 治疗和需要着急地被改善的 antithrombotic 治疗的这冷酷的地位。

ACUPUNCTURE TREATMENT OF CORONARY HEART DISEASE

In the present study, the author adopted acupuncture therapy to treat 300 cases ofcoronary heart disease by needling Dahzhong (CV 17 )-to-Jiuwei (CV 15 ), Juque(CV 14 ), Neiguan(PC 6), Zusanli (ST 36), Xinshu (BL 15 ), Jueyinshu (BL 14), etc. and adopting tonification manipulation. Results showed that after treatment, of the 300 cases, 204 (68. 0% ) experienced significant improvement and 84 (28. 0 % ) had improvement, the total effective rate was 96 %. In 201 patients with ischemic ECG, 57 (28. 4% ) had marked amelioration, 93 (46. 2% ) had amelioration, 39(19. 4 % ) had no any apparent change and 12 (6. 0 % ) worsened, with an effective rate of 74. 6 %.Ultrasound cardiogram examination displayed that after acupuncture treatment, the amplitude of vibration of the back wall and the output of the left ventricle increased significantly, the nail fold microcirculation was bettered, and the blood viscosity and the vascular resistance a1l lowered.

EFFECTS OF INJECTION OF LIGUSTRAZINE INTO GESHU (BL 17) POINT ON BLOOD RHEOLOGY IN PATIENTS OF CORONARY HEART DISEASE

In the present paper, the therapeutic effects of point-injection and electro-acupuncture(EA) were compared in 100 patients of coronary heart disease with abnormal increases of indexes ofblood rheology. Results indicated that after one therapeutic course, the increases of indexes of bloodrheology were reduced in Geshu-ligustrazine group, Geshu-saline group, Geshu-EA group and Feishu-ligustrazine group (P【0. 05 - 0. 01 ) and there was no this action in Feishu-EA group. Among them,the Geshu-EA group had the best therapeutic effect.

Clinical follow up of patients with premature coronary artery disease (PCAD) implanted with drug-eluting stents

Background: Drug-eluting stents (DESs) are associated with lower restenosis rates. However, minimal data on the follow up results of premature coronary artery disease (PCAD) treated with DESs exist. This study was to evaluate clinical characteristics and one- year prognosis of PCAD implanted with DESs in a Chinese population. Methods: 282 patients with PCAD, of which 177 implanted with DESs and 105 prescribed medicine alone were enrolled and analyzed. Major adverse cardiovascular events (MACEs) and the use of medications for secondary prevention were collected and analyzed. Results: Compared with those receiving medicine alone, patients implanted with DESs had higher ratios of males than females, they also had acute coronary syndromes, multi-vessel disease, higher values of cardiac troponin I, longer hospital stays, higher aspirin and clopidogrel use (all P β-blockers and statins use during follow-up, they had higher ratios of recurrent angina and composite MACEs during one-year follow- up (all P y syndrome (OR 1.716, 95% CI: 1.011 - 2.913) and reduced left ventricular ejection fraction (OR 2.539, 95% CI: 1.180 - 5.463) predict MACEs in a one-year follow-up among patients with PCAD. Conclusions: PCAD patients implanted with DESs have more unstable clinical phenotypes and higher MACEs during a one-year follow-up period, though they were prescribed higher ratios of optimal therapeutic medicine. Further enhanced strategies should be made for secondary prevention.

Preventing Heart Disease via Coronary Artery Calcium Scoring to Make a Definitive Diagnosis of Atherosclerosis

Purpose: Cardiovascular disease is the number one cause of death in the Western world. The purpose of this manuscript is to compare the benefits and deficiencies of coronary artery calcium scanning versus computer generated risk equations in identifying atherosclerotic cardiovascular disease. These two approaches provide significantly different cardiovascular risk assessments and often lead to therapeutic differences in recommendations from the physician to the patient. Methods: Pertinent medical literature is reviewed concerning both risk assessment approaches (i.e., coronary artery scanning and computer generated risk equations). The strengths and weaknesses of both approaches are discussed, and recommendations are provided based upon available data. Results: Cardiovascular risk equations are simple and readily obtained at no charge by physicians. However, their drawbacks are several, including non-applicability to specific populations, disagreements among different cardiovascular society risk equations, wide ranges of risk outputs (e.g., intermediate 10-year risk is between 5% and 20%), inability to definitively identify coronary artery plaques, and lack of definitive anatomical coronary disease. Alternatively, coronary artery calcium scanning costs approximately $100/scan (if not covered by insurance), requires time and effort by the patient, and exposes the patient to a minimal amount of radiation. However, coronary calcium scanning identifies specific atherosclerotic coronary disease and provides additional information about the anatomical location (i.e., coronary artery) of the atherosclerotic plaque. Conclusion: Based on the published literature, coronary artery calcium scanning is the preferred approach for identifying atherosclerotic cardiovascular disease. Although there are minor drawbacks, overall it provides superior clinical information compared with computer generated risk equations.

Review of Medical Treatment of Stable Ischemic Heart Disease

Medical treatment is the initial treatment strategy and is the cornerstone of management in patients with stable ischemic heart disease (IHD). Many patients are not suitable for percutaneous or surgical revascularization because of unfavourable anatomy, or the presence of co-morbidities. In addition, many patients have recurrence of angina following revascularization due to restenosis or incomplete revascularization. Furthermore, randomized clinical trials comparing optimal medical treatment to revascularization have not clearly shown that myocardial revascularization is superior to optimal medical treatment. Traditional drugs for angina treatment include b-blockers, calcium channel blockers and nitrates. Newer drugs are available with different mechanisms of action and with equal efficacy that do not cause significant hemodynamic deterioration. The availability of these newer drugs expands the therapeutic potential of medical treatment to even a wider population with stable IHD. Revascularization in patients with stable ischemic heart disease has never been shown to reduce hard endpoints (death or myocardial infarction) in randomized clinical trials.

Contemporary Management of Patients with Stable Ischemic Heart Disease

The overall goals of therapy for patients with stable ischemic heart disease are to minimize the likelihood of death while maximizing health and function.Initial risk assessment with noninvasive testing is indicated to determine whether invasive evaluation is needed in addition to medical therapy.All patients with stable ischemic heart disease need optimal medical therapy,which includes risk factor management with lifestyle modifi cations and pharmacologic therapy.First-line pharmacologic therapy is focused on preventing myocardial infarction and death with antiplatelet agents,lipid-lowering therapy,and antihypertensive therapies.In addition,antianginal therapy and anti-ischemic therapy are indicated to alleviate symptoms,reduce ischemia,and improve quality of life.The commonly used antianginal agents include nitrates,beta-blockers,calcium channel blockers,and ranolazine.When medical therapy is not adequate to relieve angina,revascularization with percutaneous coronary intervention or coronary artery bypass grafting is indicated.We review the indications and evidence for antianginal agents and other therapies for angina.