How and When to Decide on Revascularization in Stable Ischemic Heart Disease

  • Alicia Mecklai
  • Sripal Bangalore
  • Judith Hochman
Coronary Artery Disease (PG Steg, Section Editor)

Opinion statement

Coronary artery disease is the leading cause of death and disability worldwide. While an invasive strategy of early revascularization reduces cardiovascular morbidity and mortality in patients with acute coronary syndromes, there is no convincing evidence that this strategy leads to an incremental survival advantage for patients with stable ischemic heart disease (SIHD) beyond that achieved by optimal medical therapy. Two landmark trials, COURAGE and BARI 2D, suggest that a strategy of aggressive medical therapy is a reasonable initial approach to such patients. However, there remain certain groups of patients, those with at least moderate ischemia on baseline stress testing, where there is still clinical equipoise. Major society guidelines favor revascularization based on observational data and trials of CABG conducted decades ago, yet data from modern randomized trials are lacking. Ongoing trials such as ISCHEMIA should provide clinicians with evidence to guide selection of the appropriate initial management strategy for patients with SIHD.


Ischemia Optimal medical therapy Revascularization Stable ischemic heart disease 



A. Mecklai: none. S. Bangalore: Consultancy for Daiichii Sankyo and Boehringer Ingelheim, travel/accommodations expenses covered or reimbursed by Pfizer; J. Hochman: Consultancy for Eli Lilly and Company and Glaxo Smith Kline.

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Papers of particular interest, published recently, have been highlighted as: • Of importance: •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Alicia Mecklai
    • 1
  • Sripal Bangalore
    • 2
  • Judith Hochman
    • 2
  1. 1.Leon Charney Division of CardiologyNew York University School of MedicineNew YorkUSA
  2. 2.Cardiovascular Clinical Research Center, Leon Charney Division of CardiologyNew York University School of MedicineNew YorkUSA

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