Skip to main content
SpringerLink
Log in

Medical Treatment of Coronary Artery Disease

  • Chapter
Textbook of Angiology

  • 72 Accesses

Abstract

Current medical treatment of coronary artery disease (GAD) consists of interventions to increase coronary artery flow, reduce myocardial oxygen demand, prevent coronary artery thrombosis, and lyse existing coronary artery thrombi. The strategies used depend on the patient’s ischemic syndromes. Patients with CAD may present to the physician with stable angina, unstable angina, myocardial infarction, or silent ischemia. To a physician seeing a CAD patient for the first time, the disease may manifest itself in any one of the mentioned syndromes. Over a period of time, most patients will experience a change from one syndrome to another. Although the physician cannot eliminate CAD in a patient, the goal of therapy is to keep the patient in a stable state consistent with the best quality of life and the lowest risk from either myocardial infarction or death. Patients are at lowest risk when they are free from ischemia, whether symptomatic or silent, or are in a state of stable angina with symptoms that are infrequent and brought on only by moderate to severe exertion.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Diamond GA, Forester JS. Analysis of probability as an aid in the clinical diagnosis of coronary artery disease. N Engl J Med. 1979;300:1350–1358.

    Article  PubMed  CAS  Google Scholar 

  2. Physicians Health Study Research Group. Fiscal report on the aspirin components of the ongoing Physicians’ Heath Study. N Engl J Med. 1989;321:129–135.

    Article  Google Scholar 

  3. Mansm JE, Grobbee DE, Stampfer MJ, et al. Aspirin in the primary prevention of angina pectoris in a randomized trial of United States physicians. Am J Med. 1990;89:772–776.

    Article  Google Scholar 

  4. Ridker PM, Mansom JE, Gaziahom M, Barihg JE, Hennekens CH. Low-dose aspirin therapy for chronic stable angina. Ann Intern Med. 1991;114:835–839.

    PubMed  CAS  Google Scholar 

  5. Juul-Moller S, Edvardsson N, Jahnmatz B, et al., for the Sweden Angina Pectoris Aspirin Trial (SAPAT) Group. Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable angina pectoris. Lancet 1992;340:1421–1425.

    Google Scholar 

  6. Brown BG, Bolson E, Petersen RB, Pierce CD, Dodge HT. The mechanisms of nitroglycerin actin: stenosis vasodilation as a major component of the drug response. Circulation. 1981;64:1089–1097.

    Article  PubMed  CAS  Google Scholar 

  7. Wilkins RW, Hayes FW, Weiss S. The role of the venous system in the circulatory collapse induced by sodium nitrite. J Clin Invest. 1937;85:85–91.

    Article  Google Scholar 

  8. Horowitz JD, Antman EM, Lovell BG, et al. Potentiation of the cardiovascular effects of nitroglycerin by N-acetylcysteine. Circulation. 1983;68:1247–1253.

    Article  PubMed  CAS  Google Scholar 

  9. Murad F. Cyclic guanosine monophosphate as a mediator of vasodilation. J Clin Invest. 1986;78:1–5.

    Article  PubMed  CAS  Google Scholar 

  10. Behovic JL, Bouvier M, Caron MG, Lefkowitz RJ. Regulation of adenylcyclase-coupled beta-adrenergic receptors. Annu Rev Cell Biol. 1988;4:405–428.

    Article  Google Scholar 

  11. Lefkowitz RJ, Caron MG. Adrenergic receptors: models for the study of receptors coupled to guananine nucleotide regulatory proteins. J Biol Chem. 1988;263:4993–4996.

    PubMed  CAS  Google Scholar 

  12. Cruickshank JM. The clinical importance of cardioselectivity and lipophilicity in beta blockers. Am Heart J. 1980;100:160–178.

    Article  PubMed  CAS  Google Scholar 

  13. Braunwald E. Calcium-channel blockers: pharmacologic considerations. Am Heart J. 1982;104:665–671.

    Article  PubMed  CAS  Google Scholar 

  14. Schwartz A, Matlib A, Balwierezak J, Lathrop DA. Pharmacology of calcium antagonists. Am J Cardiol. 1985;55:3c–7c.

    Article  PubMed  CAS  Google Scholar 

  15. Flekenstein A. Specific pharmacology of calcium mycocardium, cardiac pacemakers, and vascular smooth muscles. Annu Reu Pharmacol Toxicol. 1977;17:149–166.

    Article  Google Scholar 

  16. Ellrodt G, Chew CYC, Singh BN. Therapeutic implications of slow-channel blockade in cardiocirculatory disorders. Circulation. 1980;62:669–679.

    Article  PubMed  CAS  Google Scholar 

  17. Singh BN, Nademanee K, Baky S. Calcium antagonist. Drugs. 1983;25:125–153.

    Article  PubMed  CAS  Google Scholar 

  18. Yusef S, Peto R, Lewis J, Collins R, Sleight P. β-blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335–371.

    Article  Google Scholar 

  19. Brown BG, Fuster V. Impact of management of stabilization of coronary disease. In: Fuster V, Ross R, Topol EJ, eds. Atherosclerosis and Coronary Artery Disease. Philadelphia, Pa: Lippincott-Raven; 1996:191–205.

    Google Scholar 

  20. Chin JH, Azhar S, Hoffman BB. Inactivation of endothelial derived relaxing factor by oxidized lipoproteins. J Clin Invest. 1992;89:10–18.

    Article  PubMed  CAS  Google Scholar 

  21. National Cholesterol Education Program. Second report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). Circulation. 1994;89:1329–1445.

    Google Scholar 

  22. Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990’s. Nature. 1993;362:801–809.

    Article  PubMed  CAS  Google Scholar 

  23. Kyrle Pa, Eicler HG, Jager U, Lechner K Inhibition of prostacyclin and thromboxane A2 generation by low-dose aspirin at the site of plug formation in man and in vivo. Circulation. 1987;75:1025–1029.

    Article  PubMed  CAS  Google Scholar 

  24. Patrignani P, Pilabozzi P, Patrono C. Selective cumulative inhibition of platelet thromboxane production by low dose aspirin in healthy subjects. J Clin Invest. 1982;69:1366–1372.

    Article  PubMed  CAS  Google Scholar 

  25. Steering Committee of the Physicians’ Health Study Research Group. Final report on the aspirin component of the ongoing Physicians’ Health Study. N Engl J Med. 1989;321:129–135.

    Article  Google Scholar 

  26. Fitzgerald GA. Dipyridamole. N Engl J Med. 1983;316:1247–1257.

    Google Scholar 

  27. International Anticoagulant Review Group. Collaborative analysis of long-term anticoagulant administration after acute myocardial infarction. Lancet. 1970;1:203–209.

    Google Scholar 

  28. Sixty-Plus Reinfarction Study Research Group. A double-blind trial to assess long-term oral anticoagulant therapy in elderly patients after myocardial infarction. Lancet. 1980;2:989–994.

    Google Scholar 

  29. Smith P, Arnesen H, Holme I. The effect of warfarin on mortality and reinfarction. N Engl J Med. 1990;323:147–152.

    Article  PubMed  CAS  Google Scholar 

  30. Anticoagulants in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT) Research Group. Effect of long-term oral anti-coagulant treatment on mortality and cardiovascular morbidity after myocardial infarction. Lancet 1994;343:499–503.

    Google Scholar 

  31. Morel DW, DiCorleto PE, Chisolm GM. Endothelial and smooth muscle cells alter low density lipoprotein in vitro by free radical oxidation. Arteriosclerosis. 1984;4:357–364.

    Article  PubMed  CAS  Google Scholar 

  32. Steinberg D, Parthasarathy S, Carew TE, Khoo JC, Witztum JL. Beyond cholesterol: modifications of low-density lipoproteins that increase its atherogenicity. N Engl J Med. 1989;320:915–924.

    Article  PubMed  CAS  Google Scholar 

  33. Aviram M. Modified form of low density lipo-protein and atherosclerosis. Atherosclerosis. 1993;98:1–9.

    Article  PubMed  CAS  Google Scholar 

  34. Parthasarathy S, Young SG, Witztum JL, Pittman RC, Steinberg D. Probucol inhibits oxidative modification of low density lipoprotein. J Clin Invest. 1986;77:641–644.

    Article  PubMed  CAS  Google Scholar 

  35. Daugherty A, Zweifel BS, Schofeld G. Probucol attenuates the development of aortic atherosclerosis in cholesterolfed rabbits. Br J Pharmacol. 1989;98:612–618.

    Article  PubMed  CAS  Google Scholar 

  36. Anderson TJ, Meredith IT, Charbonneau F, et al. Endothelium-dependent coronary vasomotion relates to the susceptibility of LDL to oxidation in humans. Circulation. 1996;93:1647–1650.

    Article  PubMed  CAS  Google Scholar 

  37. Stampfer MJ, Hennekens CH, Manson JE, Colditz GA, Rosner B, Willete WC. Vitamin E consumption and the risk of coronary artery disease in women. N Engl J Med. 1993;328:1444–1449.

    Article  PubMed  CAS  Google Scholar 

  38. Rimm EB, Stampfer MJ, Ascherio A, Giovannucci E, Coldiz GA, Willete WC. Vitamin E consumption and the risk of coronary disease in men. N Engl J Med. 1993;328:1450–1456.

    Article  PubMed  CAS  Google Scholar 

  39. Kushi LH, Folsom AR, Prineas RJ, Mink PJ, Wu Y, Bostick RM. Dietary antioxidant vitamins and death from coronary heart disease in postmenopausal women. N Engl J Med. 1996;334:1156–1162.

    Article  PubMed  CAS  Google Scholar 

  40. Gaziano JM, Manson JE, Buring JE, Hennekens CH. Dietary antioxidants and cardiovascular disease. Ann N Y Acad Sci. 1992;669:249–259.

    Article  PubMed  CAS  Google Scholar 

  41. Henneken CH, Buring JE, Manson JE, et al. Lack of effect of long-term supplementation with beta-carotene on incidence of malignant neoplasms and cardiovascular disease. N Engl J Med. 1996;334:1145–1149.

    Article  Google Scholar 

  42. The Alpha-Tacopherol, Beta Carotene Cancer Prevention Study Group. The effect of vitamin E and beta carotene on the incidence of lung cancer and other cancers in male smokers. N Engl J Med. 1994;330:1029–1035.

    Article  Google Scholar 

  43. Braunwald E. Unstable angina: a classification. Circulation. 1989;80:410–414.

    Article  PubMed  CAS  Google Scholar 

  44. Clinical Practice Guideline Number 10: Unstable Angina: Diagnosis and Management. Rockville, Md: US Department of Health and Human Services, Agency for Health Care Policy and Research and the National Heart, Lung, and Blood Institute; 1994. AHCPR publication 94-0602.

    Google Scholar 

  45. Sherman CT, Litvack F, Grundfest W, et al. Coronary an-gioscopy in patients with unstable angina pectoris. N Engl J Med. 1986;315:913–919.

    Article  PubMed  CAS  Google Scholar 

  46. Maseri A, L’Abbate A, Baroldi G, et al. Coronary vasospasm as a possible cause of myocardial infarction: a conclusion derived from the study of “preinfarction” angina. N Engl J Med. 1978;299:1271–1277.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  48. Cairns JA, Gent M, Singer J, et al. Aspirin, sulfinpyrazone, or both in unstable angina. N Engl J Med. 1985;313:1369–1375.

    Article  PubMed  CAS  Google Scholar 

  49. Theroux P, Qiumet H, McCans J, et al. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988;319:1105–1111.

    Article  PubMed  CAS  Google Scholar 

  50. RISC Group. Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet. 1990;336:827–830.

    Article  Google Scholar 

  51. Balsano F, Rizzon P, Violi F, et al. Antiplatelet treatment with ticlopidine: a controlled multicenter clinical trial. Circulation. 1990;82:17–26.

    Article  PubMed  CAS  Google Scholar 

  52. Theroux P, Waters D, Qui S, McCans J, De Guise P, Juneau M. Aspirin vs heparin to prevent myocardial infarction during the acute phase of unstable angina. Circulation. 1993;88(pt 1):2045–2048.

    Article  PubMed  CAS  Google Scholar 

  53. TIMI IIIA Investigators. Early effects of tissue-type plasminogen activator added to conventional therapy on the culprit coronary lesion in patients presenting with ischemic cardiac pain at rest. Circulation. 1993;87:38–52.

    Article  Google Scholar 

  54. Yusuf S, Wittes J, Friedman L. Overview of results of randomized clinical trials in heart disease, II: unstable angina, heart failure, primary prevention with aspirin, and risk factor modification. JAMA. 1988;260:2088–2093.

    Article  PubMed  CAS  Google Scholar 

  55. Held PH, Yusuf S, Furberg CD. Calcium channel blockers in acute myocardial infarction and unstable angina: an overview. BMJ. 1989;299:1187–1192.

    Article  PubMed  CAS  Google Scholar 

  56. Lubsen J, Tijssen JG. Efficacy of nifedipine and metoprolol in the early treatment of unstable angina in the coronary care unit: findings from the Holland Interuniversity Nifedipine/Metoprolol Trial (HINT). Am J Cardiol. 1987;60:18A–25A.

    Article  PubMed  CAS  Google Scholar 

  57. TIMI IIIB Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q wave myocardial infarction: results of the TIMI IIIB Trial. Circulation. 1994;89:1545–1556.

    Article  Google Scholar 

  58. Luchi RJ, Scott SM, Deupree RH, Principal Investigators, and Their Associates of Veterans Administration Cooperative Study No. 28. Comparison of medical and surgical treatment for unstable angina pectoris. N Engt J Med. 1987;316:977-984.

    Google Scholar 

  59. Russell RO, Moraski RE, Kouchokos N, et al. Unstable angina pectoris: National Cooperative Study Group to compare surgical and medical therapy, II: in-hospital experience and initial followup results in patients with one, two, and three vessel disease. Am J Cardiol. 1978;42:839–848.

    Article  Google Scholar 

  60. Mark DB, Brauwald E. Medical treatment of unstable angina. In: Fuster V, Ross R, Topol EJ, eds. Atherosclerosis and Coronary Artery Disease. Philadelphia, Pa: Lippincott-Raven; 1996:1315–1326.

    Google Scholar 

  61. Davis M, Thomas A. Plaque fissuring: the cause of acute myocardial infarction, sudden ischemic death, and crescendo angina. Br Heart J. 1985;53:363–373.

    Article  Google Scholar 

  62. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected myocardial infarctions: ISIS-2. Lancet. 1988;2:349–360.

    Google Scholar 

  63. Yusuf S, Lewis J, Collins R, Sleight P. Beta-blockade during and after acute myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335–371.

    Article  PubMed  CAS  Google Scholar 

  64. Peter T, Norris RM, Clarke ED, et al. Reduction of enzyme release after myocardial infarction in patients by propronolol. Circulation. 1978;57:1091–1095.

    Article  PubMed  CAS  Google Scholar 

  65. Yusuf S, Sleight P, Rossi PRF, et al. Reduction in infarct size, arrhythmias, chest pain, and morbidity by early intravenous blockade in suspected acute myocardial infarction. Circulation. 1983;67(pt 2):32–41.

    Google Scholar 

  66. Norris RM, Barnaby PF, Brown MA, et al. Prevention of ventricular fibrillation during acute myocardial infarction by intravenous propranolol. Lancet. 1984;2:883–886.

    Article  PubMed  CAS  Google Scholar 

  67. Frishman WH, Lazar EJ. Reduction of mortality, sudden death, and non-fatal infarction with beta-adrenergic blockers in survivors of acute myocardial infarction: a new hypothesis regarding the cardioprotective action of beta-adrenergic blockade. Am J Cardiol. 1990;65:66Gñ70G.

    Google Scholar 

  68. ISIS-1 (First International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous atenonol among 16027 cases of suspected myocardial infarction: ISIS-1. Lancet. 1988;2:57–66.

    Google Scholar 

  69. MIAMI Trial Research Group. Metoprolol in acute myocardial infarction (MIAMI): a randomized placebo controlled international trial. Eur Heart J. 1985;6:199–226.

    Google Scholar 

  70. Hjalmarson A, Elmfeldt D, Herlitz J, et al. Effect on mortality of metoprolol an acute myocardial infarction: a randomized trial. Lancet. 1981;2:823–827.

    Article  PubMed  CAS  Google Scholar 

  71. Gruppo Italiano per lo Studio della streptochinasi nell’Infarcto Miocardico (GISSI). Effectiveness of intravenous thrombolytic therapy in acute myocardial infarction. Lancet. 1986;1:397–401.

    Google Scholar 

  72. AIMS Trial Study Group. Effect of intravenous APSAC on mortality after acute myocardial infarction: preliminary report of a placebo-controlled clinical trial. Lancet. 1988;1:545–549.

    Google Scholar 

  73. DeWood MA, Spores J, Notske R, et al. Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Engl J Med. 1980;303:897–902.

    Article  PubMed  CAS  Google Scholar 

  74. Fibrinolytic Therapy Trialist (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet. 1994;343:311–322.

    Google Scholar 

  75. Gruppo Italiano per lo Studio dell Soprawivenza nell’Infarcto Miocardico GISSI-2. A factorial randomized trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet. 1990;336:65–71.

    Google Scholar 

  76. ISIS-3 (Third International Study of Infarct Survival) Collaborative Group. ISIS-3: a randomized comparison of streptokinase vs tissue plasminogen activator vs anistre-plase and of aspirin plus heparin vs aspirin alone among 41,229 cases of suspected acute myocardial infarction. Lancet. 1992;339:753–770.

    Article  Google Scholar 

  77. GUSTO Investigators. An international randomized trial comparing 4 thrombolytic agents for acute myocardial infarction. N Engl J Med. 1993;329:673–682.

    Article  Google Scholar 

  78. CONSENSUS Trial Study Group. Effects of enalapril on mortality on severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). N Engl J Med. 1987;316:1429–1435.

    Article  Google Scholar 

  79. SOLVD Investigators. Effect of enalapril on survival in patients with reduced left ventricular ejection fraction and congestive heart failure. N Engl J Med. 1991;325:293–302.

    Article  Google Scholar 

  80. Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after acute myocardial infarction. N Engl J Med. 1992;327:669–677.

    Article  PubMed  CAS  Google Scholar 

  81. Sharpe N, Murphy J, Smith H, Hannan S. Treatment of patients with symptomless left ventricular dysfunction after myocardial infarction. Lancet. 1988;1:255–259.

    Article  PubMed  CAS  Google Scholar 

  82. Pfeffer MA, Lamas GA, Vaughan GE, Parisi AF, Braunwald E. Effect of captopril on progressive left ventricular dilatation after anterior myocardial infarction. N Engl J Med. 1988;319:80–86.

    Article  PubMed  CAS  Google Scholar 

  83. Gruppo Italiano per lo Studio della Soprawivenza Nell’Infarcto Miocardio. GISSIS-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function. Lancet. 1994;343:1121–1155.

    Google Scholar 

  84. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group. ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet. 1995;345:669–685.

    Article  Google Scholar 

  85. Flather MD, Avezum A, Yusuf S. General approach to management of acute myocardial infarction. In: Fuster V, Ross R, Topol EJ, eds. Atherosclerosis and Coronary Artery Disease. Philadelphia, Pa: Lippincott-Raven; 1996:939–954.

    Google Scholar 

  86. Held P, Yusuf S. Effects of beta-blockers and calcium channel blockers in acute myocardial infarction. Eur Heart J. 1993;14(suppl F):18–25.

    Article  PubMed  Google Scholar 

  87. Furberg CD, Psaty BM, Meyer JV. Nifedipine: dose-related increase in mortality in patients with coronary artery disease. Circulation. 1995;92:1326–1331.

    Article  PubMed  CAS  Google Scholar 

  88. Teo KK, Yusuf S, Furberg CD. Effects of prophylactic antiarrhythmia drug therapy in acute myocardial infarction. JAMA. 1993;270:1589–1595.

    Article  PubMed  CAS  Google Scholar 

  89. Yusuf S, Flather M. Magnesium in acute myocardial infarction. BMJ. 1995;310:1669–1670.

    Article  Google Scholar 

  90. Glazier JJ, Chierchia S, Brown M, et al. Importance of generalized defective perception of painful stimuli as a cause of silent ischemia in chronic stable angina pectoris. Am J Cardiol. 1986;58:667–672.

    Article  PubMed  CAS  Google Scholar 

  91. Falcone C, Sconnochia R, Guasita L, et al. Dental pain threshold and angina pectoris in patients with coronary artery disease. J Am Coll Cordial. 1988;12:348–352.

    Article  CAS  Google Scholar 

  92. Sheps DS, Adams KF, Hinderliter A, et al. Endorphins are related to pain perception in coronary artery disease. Am J Cardiol. 1987;59:523–527.

    Article  PubMed  CAS  Google Scholar 

  93. Falcone C, Guasita L, Ochan M, et al. Beta-endorphins during coronary angioplasty in patients with silent or symptomatic myocardial ischemia. J Am Coll Cardiol. 1993;22:1614–1620.

    Article  PubMed  CAS  Google Scholar 

  94. Marchant B, Umachandran V, Stevenson R, Kopelman PG, Timmis AD. Silent myocardial ischemia: role of subclinical neuropathy in patients with and without diabetes. J Am Coll Cardiol. 1993;22:1433–1437.

    Article  PubMed  CAS  Google Scholar 

  95. Chierchia S, Lazzari M, Freedman B, et al. Impairment of myocardial perfusion and function during painless myocardial ischemia. J Am Coll Cardiol. 1983;1:924–930.

    Article  PubMed  CAS  Google Scholar 

  96. Deanfield JE, Ribiero P, Oakley K, et al. Analysis of ST-segment changes in normal subjects: implications for ambulatory monitoring in angina pectoris. Am J Cardiol. 1984;53:1321–1325.

    Article  Google Scholar 

  97. Deedwania PC, Carbajal EV. Silent ischemia during daily life is an independent predictor of mortality in stable angina. Circulation. 1990;81:748–756.

    Article  PubMed  CAS  Google Scholar 

  98. Weiner DA, Ryan TJ, McCabe CH, et al. Significance of myocardial ischemia during exercise testing in patients with coronary artery disease. Am J Cardiol. 1987;59:725–729.

    Article  PubMed  CAS  Google Scholar 

  99. Gottlieb S, Weisfeldt ML, Ouyang P, Mellitis D, Gersten-blith G. Silent ischemia as a marker for early unfavorable outcome in patients with unstable angina. N Engl J Med. 1986;314:1214–1219.

    Article  PubMed  CAS  Google Scholar 

  100. Nademanee K, Intarachot V, Josephson MA, Rieders D, Mody FV, Singh BN. Prognostic significance of silent myocardial ischemia in patients with unstable angina. J Am Coll Cardiol. 1987;10:1–9.

    Article  PubMed  CAS  Google Scholar 

  101. Romeo F, Rosano GMC, Martuscelli E, Valente A, Reale A. Unstable angina: role of silent ischemia and total ischemic time (silent plus painful episodes), a 6 year follownp. J Am Coll Cardiol. 1992;19:1173–1179.

    Article  PubMed  CAS  Google Scholar 

  102. Cohn PF. Silent ischemia. In: Fuster V, Ross R, Topol EJ, eds. Atherosclerosis and Coronary Artery Disease. Philadelphia, Pa: Lippincott-Raven; 1996:1561–1576.

    Google Scholar 

  103. Lim R, Dyke L, Dymond DS. Effect on prognosis of abolition of exercise-induced painless myocardial ischemia by medical therapy. Am J Cardiol. 1992;69:733–735.

    Article  PubMed  CAS  Google Scholar 

  104. Pepine CJ, Cohn PF, Deedwania PC, et al., for the ASIT Study Group. Effects of treatment on outcome in mildly symptomatic patients with ischemia during life: the Atenolol Silent Ischemia Study (ASIT). Circulation. 1994;90:762–768.

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. Ming K. Heng
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. International College of Angiology, Inc., USA

    John B. Chang MD, FACS, FICA (Chairman, Board of Directors, Director) (Chairman, Board of Directors, Director)

  2. Long Island Vascular Center, 1050, Northern Boulevard, Roslyn, NY, 11576, USA

    John B. Chang MD, FACS, FICA (Chairman, Board of Directors, Director) (Chairman, Board of Directors, Director)

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer Science+Business Media New York

About this chapter

Cite this chapter

Heng, M.K. (2000). Medical Treatment of Coronary Artery Disease. In: Chang, J.B. (eds) Textbook of Angiology. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-1190-7_18

Download citation

  • DOI: https://doi.org/10.1007/978-1-4612-1190-7_18

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4612-7039-3

  • Online ISBN: 978-1-4612-1190-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation