Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Strategies during elective PCI procedures in patients with stable angina and multivessel disease are in the majority of catheterisation laboratories, more often than not based, solely on the angiographic analysis on the spur of the moment. This despite the knowledge that angiographic images are often lacking the discriminating power to predict accurately the exact physiologic impact of individual lesions. Evidence is however accumulating telling us that routine stenting of non significant lesion is at best of no additional benefit for the patient. the introduction of dedicated angioplasty guidewires equipped at the tip with a miniature pressure-sensor has greatly expanded the possibilities to accurately evaluate the functional importance of any lesion during diagnostic coronary angiogram by measuring the FFR index. Ths index, based on the measurements of the trans-stenotic coronary gradient during maximal vasodilatation, is accurate, and easy to implement. Results from several important trials (e.g.,DEFER) have brought to our attention the fact that non significant coronary lesion sas documented by FFR measurements, in patients with single vessel disease can safely be left untreated. Recently, the remarkable results from the FAME trial have made a strong case for integrating functional evaluation as a routine work up especially in the presence of angiographic ambiguous lesions referred for PCI in patients with multivessel disease.
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PMID:Is functional assessment necessary in patients with stable angina? 2054 15

Over the past 2 decades, drug therapy of patients with stable angina pectoris has improved, with a marked impact on the hard clinical outcomes of mortality and myocardial infarction. In contrast, recent trials have not demonstrated beneficial effects of revascularization on mortality. However, in the large trials that compared medical treatment with percutaneous coronary intervention (PCI) or surgery, high-risk patients, such as those with severe 3-vessel disease with or without left ventricular dysfunction, were excluded. In the COURAGE and FAME 2 trials, the only difference between the PCI and medical therapy groups was a higher rate of revascularization in the latter. Similar findings were made in studies comparing medical treatment with coronary surgery. New pharmacological approaches are being developed to further delay the progression of atherosclerosis. These include new lipid-lowering drugs acting in concert with statins (cholesteryl ester transfer protein inhibitors, proprotein convertase subtilisin/kexin type 9 inhibitors), aldosterone antagonists, colchicine, methotrexate, and interleukin-1 inhibitors. In conclusion, from the available data, PCI and coronary surgery have not been shown to improve hard end points and routine use of invasive revascularization should be avoided in patients with chronic stable angina. Evidence-based secondary prevention remains the most important approach.
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PMID:Revascularization versus medical treatments in stable coronary artery disease: predicting the future of novel drug therapies for stable angina. 2433 13