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November 10, 2015

Evidence-Based Management of Stable Ischemic Heart DiseaseChallenges and Confusion

Author Affiliations
  • 1New York University School of Medicine, New York, New York
  • 2Stanford University School of Medicine, Stanford, California
JAMA. 2015;314(18):1917-1918. doi:10.1001/jama.2015.11219

Every year approximately 1 million percutaneous coronary interventions (PCIs) are performed in the United States and many more are performed worldwide, with a sizeable proportion (30%-45%) performed for the management of stable ischemic heart disease.1 The scientific rationale for revascularization in patients with stable ischemic heart disease is to prolong life, prevent myocardial infarction (MI), and improve quality of life, including relief of angina. However, evidence does not support routine use of a revascularization strategy for patients with stable ischemic heart disease and mild or no symptoms. Trials conducted in the “optimal medical therapy” era, such as the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, the BARI 2D (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes) trial, and the FAME 2 (Fractional Flow Reserve vs Angiography for Multivessel Evaluation 2) trial have consistently shown that a strategy of routine revascularization did not reduce death or MI when compared with optimal medical therapy alone.24

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