Controversies in Internal Medicine |

The Case for Medical Treatment in Chronic Stable Coronary Artery Disease

David T. Nash, MD
Arch Intern Med. 2005;165(22):2587-2589. doi:10.1001/archinte.165.22.2587.
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More than 1 million angioplasties and coronary bypass procedures are performed in the United States every year.1 Many patients—and their physicians as well—believe that such procedures are the best way to prevent heart attacks and to prolong survival. Actually, as Forrester and Shah2 argued as early as 1997, performing such invasive procedures immediately after making a diagnosis of stable coronary artery disease (CAD) provides little or no long-term mortality benefit over medical therapy. Additional evidence from a number of more recent studies, as reviewed below, suggests that medical treatment of low-risk stable CAD (ie, only 1 or 2 major coronary arteries narrowed by >50%, an ejection fraction >40%, and mild-to-moderate symptoms of angina pectoris) is as effective as percutaneous transluminal coronary angioplasty (PTCA) in preventing additional cardiovascular events.35 Although angioplasty may provide more rapid symptomatic relief and is clearly appropriate for high-risk patients with poor symptom control, it does not improve long-term survival or better prevent acute myocardial infarction in low-risk patients with stable CAD.

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