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Coronary Heart Disease pp 271–290Cite as

Chronic Stable Angina

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Abstract

Millions live with chronic stable angina. Incidence is likely to grow as the population ages and as risk factors increase. Similarly, treatment options are expanding. Medical therapies from drug regimens to percutaneous coronary intervention and coronary artery bypass grafts are significantly reducing morbidity and mortality, with additional experimental therapies on the horizon. This chapter describes these therapies as well as how stable angina is diagnosed and prognosis determined. It also presents the results of multiple clinical studies that evaluated treatment options for improving symptoms and prolonging life. Clinical data help clarify whether optimal medical therapy or revascularization is the better option for individual patients.

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References

  1. Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for the management of patients with chronic stable angina). 17 Nov 2002. http://www.americanheart.org/downloadable/heart/1044991838085StableAnginaNewFigs.pdf. Accessed 21 May 2010.

  2. The American Heart Association. Heart and stroke. Statistical update. Dallas: American Heart Association; 1999.

    Google Scholar 

  3. Kannel WB, Feinleib M. Natural history of angina pectoris in the Framingham study. Prognosis and survival. Am J Cardiol. 1972;29:154–63.

    Article  PubMed  CAS  Google Scholar 

  4. Writing Group for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Five-year clinical and functional outcome comparing bypass surgery and angioplasty in patients with multivessel coronary disease: a multicenter randomized trial. JAMA. 1997;277:715–21.

    Article  Google Scholar 

  5. Diamond GA, Forester JS. Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease. N Engl J Med. 1979;300:1350–8.

    Article  PubMed  CAS  Google Scholar 

  6. Chaitman BR, Bourassa MG, Davis K, et al. Angiographic prevalence of high-risk coronary artery disease in patient subsets (CASS). Circulation. 1981;64:360–7.

    Article  PubMed  CAS  Google Scholar 

  7. Gibbons RJ, Balady GJ, Bricker JT, et al. ACC/AHA 2002 guideline update for exercise testing: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). Circulation. 2002;106(14):1883–92.

    Article  PubMed  Google Scholar 

  8. Morise AP, Diamond GA. Comparison of the sensitivity and specificity of exercise electrocardiography in biased and unbiased populations of men and women. Am Heart J. 1995;130:741–7.

    Article  PubMed  CAS  Google Scholar 

  9. Froelicher VF, Lehmann KG, Thomas R, et al. The electrocardiographic exercise test in a population with reduced workup bias: diagnostic performance, computerized interpretation, and multi-variable prediction. Veterans Affairs Cooperative Study in Health Services #016 (QUEXTA) Study Group. Quantitative exercise testing and angiography. Ann Intern Med. 1998;128:965–74.

    PubMed  CAS  Google Scholar 

  10. Marcus ML, Chilian WM, Kanatsuka H, Dellsperger KC, Eastham CL, Lamping KG. Understanding the coronary circulation through ­studies at the microvascular level. Circulation. 1990;82:1–7.

    Article  PubMed  CAS  Google Scholar 

  11. Kern M, Lim M. Grossman’s cardiac catheterization, angiography and intervention. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2005.

    Google Scholar 

  12. Wilson RF. Assessing the severity of coronary-artery stenoses [editorial]. N Engl J Med. 1996;334:1735–7.

    Article  PubMed  CAS  Google Scholar 

  13. Mock MB, Ringqvist I, Fisher LD, et al. Survival of medically treated patients in the Coronary Artery Surgery Study (CASS) registry. Circulation. 1982;66:562–8.

    Article  PubMed  CAS  Google Scholar 

  14. Weiner DA, Ryan TJ, McCabe CH, et al. Prognostic importance of a clinical profile and exercise test in medically treated patients with ­coronary artery disease. J Am Coll Cardiol. 1984;3:772–9.

    Article  PubMed  CAS  Google Scholar 

  15. Hammermeister KE, DeRouen TA, Dodge HT. Variables predictive of survival in patients with coronary disease. Selection by univariate and multivariate analyses from the clinical, electrocardiographic, exercise, arteriographic, and quantitative angiographic evaluations. Circulation. 1979;59:421–30.

    Article  PubMed  CAS  Google Scholar 

  16. Block Jr WJ, Crumpacker EL, Dry TJ, Gage RP. Prognosis of angina pectoris: observations in 6,882 cases. JAMA. 1952;150:259–64.

    Article  Google Scholar 

  17. Califf RM, Armstrong PW, Carver JR, et al. Task Force 5. Stratification of patients into high-, medium-, and low-risk subgroups for purposes of risk factor management. J Am Coll Cardiol. 1996;27:964–1047.

    Article  Google Scholar 

  18. Pontone G, Andreini D, Bartorelli AL, et al. Diagnostic accuracy of coronary computed tomography angiography: a comparison between prospective and retrospective electrocardiogram triggering. J Am Coll Cardiol. 2009;54:346–55.

    Article  PubMed  Google Scholar 

  19. Ritchie JL, Bateman TM, Bonow RO, et al. Guidelines for clinical use of cardiac radionuclide imaging. Report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Radionuclide Imaging), developed in collaboration with the American Society of Nuclear Cardiology. J Am Coll Cardiol. 1995;25:521–47.

    Article  PubMed  CAS  Google Scholar 

  20. Cheitlin MD, Alpert JS, Armstrong WF, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography). Developed in collaboration with the American Society of Echocardiography. Circulation. 1997;95:1686–744.

    Article  PubMed  CAS  Google Scholar 

  21. Cassar A, Holmes D, Rihal C, Gersh B. Chronic coronary artery disease: diagnosis and management. Mayo Clin Proc. 2009;84(12):1130–46.

    Article  PubMed  CAS  Google Scholar 

  22. Mark DB, Hlatky MA, Harrell Jr FE, Lee KL, Califf RM, Pryor DB. Exercise treadmill score for predicting prognosis in coronary artery disease. Ann Intern Med. 1987;106(6):793–800.

    PubMed  CAS  Google Scholar 

  23. Pyorala K, De Backer G, Graham I, Poole-Wilson P, Wood D. Prevention of coronary heart disease in clinical practice: recommendations of the Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension. Atherosclerosis. 1994;110:121–61.

    Article  PubMed  CAS  Google Scholar 

  24. US Department of Health and Human Services. The health benefits of smoking cessation. A report of the surgeon general. Washington, DC: US Department of Health and Human Services; 1990.

    Google Scholar 

  25. Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial. Risk factor changes and mortality results. JAMA. 1982;248:1465–77.

    Article  Google Scholar 

  26. Hjermann I, Velve Byre K, Holme I, Leren P. Effect of diet and smoking intervention on the incidence of coronary heart disease. Report from the Oslo Study Group of a randomised trial in healthy men. Lancet. 1981;2:1303–10.

    Article  PubMed  CAS  Google Scholar 

  27. Singh RB, Rastogi SS, Verma R, et al. Randomised controlled trial of cardioprotective diet in patients with recent acute myocardial infarction: results of one year follow up. BMJ. 1992;304:1015–9.

    Article  PubMed  CAS  Google Scholar 

  28. Schuler G, Hambrecht R, Schlierf G, et al. Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease. Circulation. 1992;86:1–11.

    Article  PubMed  CAS  Google Scholar 

  29. Smith Jr SC, Blair SN, Criqui MH, et al. AHA consensus panel statement: preventing heart attack and death in patients with coronary ­disease. The Secondary Prevention Panel. J Am Coll Cardiol. 1995;26:292–4.

    Article  PubMed  Google Scholar 

  30. Superko HR, Krauss RM. Coronary artery disease regression: convincing evidence for the benefit of aggressive lipoprotein management. Circulation. 1994;90:1056–69.

    Article  PubMed  CAS  Google Scholar 

  31. Rossouw JE. Lipid-lowering interventions in angiographic trials. Am J Cardiol. 1995;76:86C–92.

    Article  PubMed  CAS  Google Scholar 

  32. The fifth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure (JNC V). Arch Intern Med. 1993;153:154–83

    Google Scholar 

  33. Stamler J, Neaton J, Wentworth D. Blood pressure (systolic and diastolic) and risk of fatal coronary heart disease. Hypertension. 1993;13:2–12.

    Article  Google Scholar 

  34. MacMahon S, Peto R, Cutler J, et al. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335:765–74.

    Article  PubMed  CAS  Google Scholar 

  35. Effects of treatment on morbidity in hypertension: results in patients with diastolic blood pressures averaging 115 through 129 mm Hg. JAMA. 1967;202:1028–34.

    Google Scholar 

  36. Effects of treatment on morbidity in hypertension, II: results in patients with diastolic blood pressure averaging 90 through 114 mm Hg. JAMA. 1970;213:1143–52.

    Google Scholar 

  37. Collins R, Peto R, MacMahon S, et al. Blood pressure, stroke, and coronary heart disease. Part 2, short-term reductions in blood pressure: overview of randomised drug trials in their epidemiological context. Lancet. 1990;335:827–38.

    Article  PubMed  CAS  Google Scholar 

  38. Cutler JA, Psaty BM, McMahon S, Furberg CD. Public health issues in hypertension control: what has been learned from clinical trials. In: Laragh JH, Brenner BM, editors. Hypertension: pathophysiology, diagnosis, and management. 2nd ed. New York: Raven; 1995. p. 253–70.

    Google Scholar 

  39. Neaton JD, Grimm RH, Prineas RJ, et al. Treatment of Mild Hypertension Study. Final results. Treatment of Mild Hypertension Study Research Group. JAMA. 1993;270:713–24.

    Article  PubMed  CAS  Google Scholar 

  40. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352:1425–35.

    Article  PubMed  CAS  Google Scholar 

  41. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837–53.

    Article  Google Scholar 

  42. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet. 1998;352:854–65.

    Article  Google Scholar 

  43. Reichard P, Nilsson BY, Rosenqvist U. The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus. N Engl J Med. 1993;329:304–9.

    Article  PubMed  CAS  Google Scholar 

  44. Takaro T, Hultgren H, Lipton M, Detre K. The Veterans Administration randomized study of surgery for coronary arterial occlusive disease II. Subgroup with significant left main lesions. Circulation. 1976;54(6 Suppl):III107–17.

    PubMed  CAS  Google Scholar 

  45. European Coronary Surgery Study Group. Coronary artery bypass surgery in stable angina pectoris: survival at two years. Lancet. 1979;1:889–93.

    Google Scholar 

  46. CASS Principal Investigators and Their Associates. Myocardial infarction and mortality in the Coronary Artery Surgery Study (CASS) randomized trial. N Engl J Med. 1984;310:750–8.

    Article  Google Scholar 

  47. Frye R, Fisher L, Schaff H, Gersh B, Vlietstra R, Mock M. Randomized trials in coronary artery bypass surgery. Prog Cardiovasc Dis. 1987;30:1–22.

    Article  PubMed  CAS  Google Scholar 

  48. Boden WE, O’Rourke RA, Teo KK, et al; for the COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–16.

    Article  Google Scholar 

  49. Frishman WH, Heiman M, Soberman J, Greenberg S, Eff J. Comparison of celiprolol and propranolol in stable angina pectoris. Celiprolol International Angina Study Group. Am J Cardiol. 1991;67:665–70.

    Article  PubMed  CAS  Google Scholar 

  50. Narahara KA. Double-blind comparison of once daily betaxolol versus propranolol four times daily in stable angina pectoris. Betaxolol Investigators Group. Am J Cardiol. 1990;65:577–82.

    Article  PubMed  CAS  Google Scholar 

  51. Hauf-Zachariou U, Blackwood RA, Gunawardena KA, O’Donnell JG, Garnham S, Pfarr E. Carvedilol versus verapamil in chronic stable angina: a multicentre trial. Eur J Clin Pharmacol. 1997;52:95–100.

    Article  PubMed  CAS  Google Scholar 

  52. Raftery EB. The preventative effects of vasodilating beta-blockers in cardiovascular disease. Eur Heart J. 1996;17(Suppl B):30–8.

    Article  PubMed  CAS  Google Scholar 

  53. McLenachan JM, Findlay IN, Wilson JT, Dargie HJ. Twenty-four-hour beta-blockade in stable angina pectoris: a study of atenolol and betaxolol. J Cardiovasc Pharmacol. 1992;20:311–5.

    Article  PubMed  CAS  Google Scholar 

  54. Prida XE, Hill JA, Feldman RL. Systemic and coronary hemodynamic effects of combined alpha- and beta-adrenergic blockade (labetalol) in normotensive patients with stable angina pectoris and positive exercise stress test responses. Am J Cardiol. 1987;59:1084–8.

    Article  PubMed  CAS  Google Scholar 

  55. Capone P, Mayol R. Celiprolol in the treatment of exercise induced angina pectoris. J Cardiovasc Pharmacol. 1986;8 Suppl 4:S135–7.

    Article  PubMed  Google Scholar 

  56. Ryden L. Efficacy of epanolol versus metoprolol in angina pectoris: report from a Swedish multicentre study of exercise tolerance. J Intern Med. 1992;231:7–11.

    Article  PubMed  CAS  Google Scholar 

  57. Boberg J, Larsen FF, Pehrsson SK. The effects of beta blockade with (epanolol) and without (atenolol) intrinsic sympathomimetic activity in stable angina pectoris. The Visacor Study Group. Clin Cardiol. 1992;15:591–5.

    Article  PubMed  CAS  Google Scholar 

  58. CAPRICORN Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001;357:1385–90.

    Article  Google Scholar 

  59. Beta-Blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. Mortality results. JAMA. 1982;247:1707–14.

    Article  Google Scholar 

  60. Norwegian Multicenter Study Group. Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial ­infarction. N Engl J Med. 1981;304:801–7.

    Article  Google Scholar 

  61. Wallace WA, Wellington KL, Chess MA, Liang CS. Comparison of nifedipine gastrointestinal therapeutic system and atenolol on antianginal efficacies and exercise hemodynamic responses in stable angina pectoris. Am J Cardiol. 1994;73:23–8.

    Article  PubMed  CAS  Google Scholar 

  62. de Vries RJ, van den Heuvel AF, Lok DJ, et al. Nifedipine gastrointestinal therapeutic system versus atenolol in stable angina pectoris. The Netherlands Working Group on Cardiovascular Research (WCN). Int J Cardiol. 1996;57:143–50.

    Article  PubMed  Google Scholar 

  63. Fox KM, Mulcahy D, Findlay I, Ford I, Dargie HJ. The Total Ischaemic Burden European Trial (TIBET). Effects of atenolol, nifedipine SR and their combination on the exercise test and the total ischaemic burden in 608 patients with stable angina. The TIBET Study Group. Eur Heart J. 1996;17:96–103.

    Article  PubMed  CAS  Google Scholar 

  64. Parmley WW, Nesto RW, Singh BN, Deanfield J, Gottlieb SO. Attenuation of the circadian patterns of myocardial ischemia with nifedipine GITS in patients with chronic stable angina. N-CAP Study Group. J Am Coll Cardiol. 1992;19:1380–9.

    Article  PubMed  CAS  Google Scholar 

  65. Tatti P, Pahor M, Byington RP, et al. Outcome results of the Fosinopril Versus Amlodipine Cardiovascular Events Randomized Trial (FACET) in patients with hypertension and non-insulin dependent diabetes mellitus. Diabetes Care. 1998;21:597–603.

    Article  PubMed  CAS  Google Scholar 

  66. Singh BN. Comparative efficacy and safety of bepridil and diltiazem in chronic stable angina pectoris refractory to diltiazem. The Bepridil Collaborative Study Group. Am J Cardiol. 1991;68:306–12.

    Article  PubMed  CAS  Google Scholar 

  67. Furberg CD, Psaty BM, Meyer JV. Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation. 1995;92:1326–31.

    Article  PubMed  CAS  Google Scholar 

  68. Kaski JC, Plaza LR, Meran DO, Araujo L, Chierchia S, Maseri A. Improved coronary supply: prevailing mechanism of action of nitrates in chronic stable angina. Am Heart J. 1985;110:238–45.

    Article  PubMed  CAS  Google Scholar 

  69. Lacoste LL, Theroux P, Lidon RM, Colucci R, Lam JY. Anti-thrombotic properties of transdermal nitroglycerin in stable angina pectoris. Am J Cardiol. 1994;73:1058–62.

    Article  PubMed  CAS  Google Scholar 

  70. Tirlapur VG, Mir MA. Cardiorespiratory effects of isosorbide dinitrate and nifedipine in combination with nadolol: a double-blind comparative study of beneficial and adverse antianginal drug interactions. Am J Cardiol. 1984;53:487–92.

    Article  PubMed  CAS  Google Scholar 

  71. Schneider W, Maul FD, Bussmann WD, Lang E, Hor G, Kaltenbach M. Comparison of the antianginal efficacy of isosorbide dinitrate (ISDN) 40 mg and verapamil 120 mg three times daily in the acute trial and following two-week treatment. Eur Heart J. 1988;9:149–58.

    PubMed  CAS  Google Scholar 

  72. Ankier SI, Fay L, Warrington SJ, Woodings DF. A multicentre open comparison of isosorbide-5-mononitrate and nifedipine given prophylactically to general practice patients with chronic stable angina pectoris. J Int Med Res. 1989;17:172–8.

    PubMed  CAS  Google Scholar 

  73. Emanuelsson H, Ake H, Kristi M, Arina R. Effects of diltiazem and isosorbide-5-mononitrate, alone and in combination, on patients with stable angina pectoris. Eur J Clin Pharmacol. 1989;36:561–5.

    Article  PubMed  CAS  Google Scholar 

  74. Akhras F, Chambers J, Jefferies S, Jackson G. A randomised double-blind crossover study of isosorbide mononitrate and nifedipine retard in chronic stable angina. Int J Cardiol. 1989;24:191–6.

    Article  PubMed  CAS  Google Scholar 

  75. Akhras F, Jackson G. Efficacy of nifedipine and isosorbide mononitrate in combination with atenolol in stable angina. Lancet. 1991;338:1036–9.

    Article  PubMed  CAS  Google Scholar 

  76. Ridker PM, Manson JE, Gaziano JM, Buring JE, Hennekens CH. Low-dose aspirin therapy for chronic stable angina. A randomized, ­placebo-controlled clinical trial. Ann Intern Med. 1991;114:835–9.

    PubMed  CAS  Google Scholar 

  77. Antiplatelet Trialists Collaboration. Collaborative overview of randomised trials of antiplatelet therapy, I: prevention of death, myocardial infarction and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1995;308:81–106.

    Google Scholar 

  78. Lewis HD, Davis JW, Archibald DG, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina: results of a Veterans Administration cooperative study. N Engl J Med. 1983;309:396–403.

    Article  PubMed  Google Scholar 

  79. Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina. Results of a Canadian multicenter trial. N Engl J Med. 1985;313:1369–75.

    Article  PubMed  CAS  Google Scholar 

  80. Juul-Moller S, Edvardsson N, Jahnmatz B, Rosen A, Sorensen S, Omblus R. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris. The Swedish Angina Pectoris Aspirin Trial (SAPAT) Group. Lancet. 1992;340:1421–5.

    Article  PubMed  CAS  Google Scholar 

  81. The Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;3457:494–502.

    Google Scholar 

  82. Mehta SR, Yusuf S, Peters RJG, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358:527–33.

    Article  PubMed  CAS  Google Scholar 

  83. Bhatt D, Fox KA, Hacke W, et al; for the CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354(16):1706–17.

    Article  Google Scholar 

  84. The Medical Research Council’s General Practice Research Framework. Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk. Lancet. 1998;351:233–41.

    Article  Google Scholar 

  85. The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–53.

    Article  Google Scholar 

  86. The EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators. Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study). Lancet. 2003;362(9399):1935.

    Google Scholar 

  87. Larosa JC, Hunninghake D, Bush D, et al. The cholesterol facts: a summary of the evidence relating dietary fats, serum cholesterol, and coronary heart disease. A joint statement by the American Heart Association and the National Heart, Lung, and Blood Institute. The Task Force on Cholesterol Issues, American Heart Association. Circulation. 1990;81:1721–33.

    Article  PubMed  CAS  Google Scholar 

  88. Gould AL, Rossouw JE, Santanello NC, Heyse JF, Furberg CD. Cholesterol reduction yields clinical benefit: impact of statin trials. Circulation. 1998;97:946–52.

    Article  PubMed  CAS  Google Scholar 

  89. Sacks FM, Pfeffer MA, Moye LA, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med. 1996;335:1001–9.

    Article  PubMed  CAS  Google Scholar 

  90. Diamond GA, Kaul S. COURAGE under fire. On the management of stable coronary disease. J Am Coll Cardiol. 2007;50:1604–9.

    Article  PubMed  Google Scholar 

  91. Kereikaes DJ, Teirstein PS, Sarembock IJ, et al. The truth and consequences of the COURAGE trial. J Am Coll Cardiol. 2007;50:1598–603.

    Article  Google Scholar 

  92. BARI 2D Study Group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med. 2009;360(24):2503–15.

    Article  Google Scholar 

  93. Weintraub WS, Boden WE, Zhang Z, et al. Cost-effectiveness of percutaneous coronary intervention in optimally treated stable coronary patients. Circ Cardiovasc Qual Outcomes. 2008;1:12–20.

    Article  PubMed  Google Scholar 

  94. Krone RJ, Shaw RE, Klein LW, et al. Ad hoc percutaneous coronary interventions in patients with stable coronary artery disease – a study of prevalence, safety, and variation in use from the America College of Cardiology National Cardiovascular Data Registry (ACC-NCDR). Catheter Cardiovasc Interv. 2006;68:696–703.

    Article  PubMed  Google Scholar 

  95. Hannan E, Racz MJ, Gold J, et al. Adherence of catheterization laboratory cardiologists to American College of Cardiology/American Heart Association guidelines for percutaneous coronary interventions and coronary artery bypass graft surgery. What happens in actual practice? Circulation. 2010;121:267–75.

    Article  PubMed  Google Scholar 

  96. Gawande A. The cost conondrum. New Yorker, 1 June 2009.

    Google Scholar 

  97. Lin GA, Dudley RA, Lucas FL, et al. Frequency of stress testing to document ischemia prior to elective percutaneous coronary intervention. JAMA. 2008;300(15):1765–73.

    Article  PubMed  CAS  Google Scholar 

  98. Gould KL, Lipscomb K, Hamilton GW. Physiologic basis for assessing critical coronary stenosis: instantaneous flow response and regional distribution during coronary hyperemia as measures of coronary flow reserve. Am J Cardiol. 1974;33:87–94.

    Article  PubMed  CAS  Google Scholar 

  99. Wilson RF, Marcus ML, White CW. Prediction of the physiologic significance of coronary arterial lesions by quantitative lesion geometry in patients with limited coronary artery disease. Circulation. 1987;75:723–32.

    Article  PubMed  CAS  Google Scholar 

  100. White CW, Wright CB, Doty DB, et al. Does visual interpretation of the coronary arteriogram predict the physiologic importance of a coronary stenosis? N Engl J Med. 1984;310:819–24.

    Article  PubMed  CAS  Google Scholar 

  101. Tonino PA, De Bruyne B, Pijls NHJ, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009;360:213–24.

    Article  PubMed  CAS  Google Scholar 

  102. Pijls NH, van Schaardenburgh P, Manoharan G, et al. Percutaneous coronary intervention of functionally nonsignificant stenosis: 5-year follow-up of the DEFER Study. J Am Coll Cardiol. 2007;49:2105–11.

    Article  PubMed  Google Scholar 

  103. Hachamovitch R, Hayes SW, Friedman JD, et al. Comparison of short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107(23):2900–7.

    Article  PubMed  Google Scholar 

  104. Shaw L, Berman D, Baron DJ, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden. Results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial Nuclear Substudy. Circulation. 2008;117:1283–91.

    Article  PubMed  Google Scholar 

  105. Hannan EL, Racz M, Holmes DR, et al. Impact of completeness of percutaneous coronary intervention revascularization on long-term ­outcomes in the stent era. Circulation. 2006;113:2406–12.

    Article  PubMed  Google Scholar 

  106. Van den Brand MJ, Rensing BJ, Morel MA, et al. The effect of completeness of revascularization on event-free survival at one year in the ARTS trial. J Am Coll Cardiol. 2002;39:559–64.

    Article  PubMed  Google Scholar 

  107. Rider J, Ward H, Moritz T, et al. Preoperative coronary artery revascularization and long-term outcome in patients with abdominal aortic operations and myocardial ischemia on SPECT: a post-hoc analysis of the CARP Trial [abstract 3346]. Circulation. 2006;114:II 711.

    Google Scholar 

  108. Favaloro RG. Saphenous vein graft in the surgical treatment of coronary artery disease. J Thorac Cardiovasc Surg. 1969;58:178.

    PubMed  CAS  Google Scholar 

  109. Yusuf S, Zucker D, Peduzzi P, et al. Coronary artery bypass grafting (CABG): randomized studies comparing survival with CABG vs ­medical treatment. Lancet. 1994;334:563–70.

    Article  Google Scholar 

  110. Lloyd-Jones D, Adams R, Carnethon M, et al. AHA Statistics Committee and Stroke Statistics Subcommittee – 2009 update: a report from the AHA Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009;119(3):480–6.

    Article  PubMed  Google Scholar 

  111. Bravaia DM, Glenger AL, McDonald KM, et al. Systematic review: the comparative effectiveness of percutaneous coronary interventions and coronary artery bypass graft surgery. Ann Intern Med. 2007;147(10):703–16.

    Google Scholar 

  112. BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol. 2007;49(15):1600–6.

    Article  Google Scholar 

  113. Rodriguez A, Rodriguez Alemparte M, Baldi J, et al. Coronary stenting versus coronary bypass surgery in patients with multiple vessel disease and significant proximal LAD stenosis: results from the ERACl II study. Heart. 2003;89(2):184–8.

    Article  PubMed  CAS  Google Scholar 

  114. Investigators SoS. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with ­multivessel coronary artery disease (the Stent or Surgery trial): a randomised controlled trial. Lancet. 2002;360(9338):965–70.

    Article  Google Scholar 

  115. Serruys PW, Ong AT, van Herwerden LA, et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of ­multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J Am Coll Cardiol. 2005;46(4):575–81.

    Article  PubMed  Google Scholar 

  116. Hannan EL, Racz MJ, Walford G, et al. Long-term outcomes of coronary artery bypass grafting versus stent implantation. N Engl J Med. 2005;352(21):2174–83.

    Article  PubMed  CAS  Google Scholar 

  117. Hlatky MA, Boothrnyd DB, Bravata DM, et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet. 2009;373(9670):1190–7.

    Article  PubMed  Google Scholar 

  118. Taggart DP, D’Amico R, Altman DG. Effect of arterial revascularisation on survival: a systematic review of studies comparing bilateral and single internal mammary arteries. Lancet. 2001;358(9285):870–5.

    Article  PubMed  CAS  Google Scholar 

  119. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360(10):961–72.

    Article  PubMed  CAS  Google Scholar 

  120. Emond M, Mock MB, David KB, et al. Long-term survival of medically treated patients in the Coronary Artery Surgery Study (CASS) registry. Circulation. 1994;90:2645–57.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, University of Minnesota, Minneapolis VA Medical Center, One Veterans Drive (111-C), Minneapolis, MN, 55417, USA

    Santiago Garcia MD & Edward O. McFalls MD, PhD

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  1. Santiago Garcia MD
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  2. Edward O. McFalls MD, PhD
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Correspondence to Santiago Garcia MD .

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  1. Edgcumbe Place 6, St. Paul, 55116, Minnesota, USA

    Zeev Vlodaver

  2. University of Minnesota, Delaware Street S.E. 420, Minneapolis, 55455, Minnesota, USA

    Robert F. Wilson

  3. 4-112 Nils Hasselmo Hall, University of Minnesota, Church Street S.E. 312, Minneapolis, 55455, Minnesota, USA

    Daniel J. Garry

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Garcia, S., McFalls, E.O. (2012). Chronic Stable Angina. In: Vlodaver, Z., Wilson, R., Garry, D. (eds) Coronary Heart Disease. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-1475-9_15

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