Stable Ischemic Heart Disease

  • Erik H. HowellEmail author
  • Christopher J. Cove


Coronary artery disease is the leading cause of mortality and morbidity worldwide. Stable ischemic heart disease encompasses a spectrum from asymptomatic to severely symptomatic to sudden cardiac death. Angina is the physical manifestation of the ischemic constellation and is the earliest sign in about half of patients with coronary artery disease (Maznyczka et al., Open Heart 2(1):e000178, 2015; Ohman, N Engl J Med 374(12):1167–1176, 2016). Angina is associated with reduced quality of life, decreased work productivity, impaired physical functioning, psychosocial distress, and frequent hospital admissions (Piccolo et al., Lancet 386(9994):702–713, 2015). Management of stable ischemic heart disease is aimed at treating modifiable risk factors, eliminating or lessening angina, improving quality of life, and reducing premature cardiovascular death.


Angina Stable angina Chest pain Coronary artery disease Ischemic heart disease 


  1. 1.
    Writing Group Members, Mozaffarian D, Benjamin EJ, et al. Heart disease and stroke Statistics-2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38–360. Scholar
  2. 2.
    Jones M, Rait G, Falconer J, Feder G. Systematic review: prognosis of angina in primary care. Fam Pract. 2006;23(5):520–8. Scholar
  3. 3.
    Eisen A, Bhatt DL, Steg PG, et al. Angina and future cardiovascular events in stable patients with coronary artery disease: insights from the reduction of atherothrombosis for continued health (REACH) registry. J Am Heart Assoc. 2016;5(10):e004080. Scholar
  4. 4.
    Hemingway H, Langenberg C, Damant J, Frost C, Pyörälä K, Barrett-Connor E. Prevalence of angina in women versus men: a systematic review and meta-analysis of international variations across 31 countries. Circulation. 2008;117(12):1526–36. Scholar
  5. 5.
    Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2012;60(24):e44. Scholar
  6. 6.
    Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014;64(18):1929–49. Scholar
  7. 7.
    Montalescot G, Sechtem U, Achenbach S, et al. 2013 ESC guidelines on the management of stable coronary artery disease. Eur Heart J. 2013;34(38):2949–3003. Scholar
  8. 8.
    Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article. J Am Coll Cardiol. 2003;41(1):159–68. Scholar
  9. 9.
    Mayo Clinic Cardiovascular Working Group on Stress Testing. Cardiovascular stress testing: a description of the various types of stress tests and indications for their use. Mayo Clin Proc. 1996;71(1):43–52. Scholar
  10. 10.
    Bourque JM, Beller GA. Value of exercise ECG for risk stratification in suspected or known CAD in the era of advanced imaging technologies. JACC Cardiovasc Imaging. 2015;8(11):1309–21. Scholar
  11. 11.
    Kato S, Saito N, Nakachi T, et al. Stress perfusion coronary flow reserve versus cardiac magnetic resonance for known or suspected CAD. J Am Coll Cardiol. 2017;70(7):869–79. Scholar
  12. 12.
    Chang SM, Bhatti S, Nabi F. Coronary computed tomography angiography. Curr Opin Cardiol. 2011;26(5):392–402. Scholar
  13. 13.
    O’Rourke RA, Brundage BH, Froelicher VF, et al. American College of Cardiology/American Heart Association expert consensus document on electron-beam computed tomography for the diagnosis and prognosis of coronary artery disease. J Am Coll Cardiol. 2000;36(1):326–40. Scholar
  14. 14.
    Califf RM, Armstrong PW, Carver JR, D’Agostino RB, Strauss WE. Task force 5. Stratification of patients into high, medium and low risk subgroups for purposes of risk factor management. J Am Coll Cardiol. 1996;27(5):1007–19. Scholar
  15. 15.
    The SPRINT Research Group, Wright JT, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373:2103–16. Scholar
  16. 16.
    National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(2 Suppl 1):S1–266. Accessed 4 Nov 2017.
  17. 17.
    May HT, Horne BD, Knight S, et al. The association of depression at any time to the risk of death following coronary artery disease diagnosis. Eur Heart J Qual Care Clin Outcomes. 2017;3(4):296–302. Scholar
  18. 18.
    Ohman EM. Chronic stable angina. N Engl J Med. 2016;374(12):1167–76. Scholar
  19. 19.
    Husted SE, Ohman EM. Pharmacological and emerging therapies in the treatment of chronic angina. Lancet. 2015;386(9994):691–701. Scholar
  20. 20.
    Piccolo R, Giustino G, Mehran R, Windecker S. Stable coronary artery disease: revascularisation and invasive strategies. Lancet. 2015;386(9994):702–13. Scholar
  21. 21.
    RITA-2 trial participants. Coronary angioplasty versus medical therapy for angina: the second randomised intervention treatment of angina (RITA-2) trial. RITA-2 trial participants. Lancet. 1997;350(9076):461–8; S014067369707298X [pii]CrossRefGoogle Scholar
  22. 22.
    Parisi A, Folland E, Hartigan PM, Investigators VAA. A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. N Engl J Med. 1992;327(4):248–54. Scholar
  23. 23.
    Folland M, Hartigan P, Parisi M. Percutaneous transluminal coronary angioplasty versus medical therapy for stable angina pectoris: outcomes for patients with double-vessel versus single-vessel coronary artery disease in a veterans affairs cooperative randomized trial. J Am Coll Cardiol. 1997;29(7):1505–11. Scholar
  24. 24.
    Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, John Mancini GB, Weintraub WS, COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503–16. Scholar
  25. 25.
    Shaw LJ, Weintraub WS, Maron DJ, et al. Baseline stress myocardial perfusion imaging results and outcomes in patients with stable ischemic heart disease randomized to optimal medical therapy with or without percutaneous coronary intervention. Am Heart J. 2012;164(2):243–50. Scholar
  26. 26.
    Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS. Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation. 2003;107(23):2900–6. Scholar
  27. 27.
    Windecker S, Stortecky S, Stefanini GG, et al. Revascularisation versus medical treatment in patients with stable coronary artery disease: network meta-analysis. BMJ. 2014;348(jun23 8):g3859. Scholar
  28. 28.
    Serruys PW, Unger F, Sousa JE, Jatene A, Bonnier HJ, Schönberger JP, Buller N, Bonser R, van den Brand MJ, van Herwerden LA, Morel MA, van Hout BA, Arterial Revascularization Therapies Study Group. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med. 2001;344(15):1117–24.CrossRefPubMedGoogle Scholar
  29. 29.
    Investigators TBAR. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med. 1996;335(4):217–26.CrossRefGoogle Scholar
  30. 30.
    Serruys PW, Morice M-C, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360(10):961–72. Scholar
  31. 31.
    Farkouh ME, Domanski M, Sleeper LA, Siami FS, Dangas G, Mack M, Yang M, Cohen DJ, Rosenberg Y, Solomon SD, Desai AS, Gersh BJ, Magnuson EA, Lansky A, Boineau R, Weinberger J, Ramanathan K, Sousa JE, Rankin J, Bhargava B, Buse J, Hueb W, Smith CR, Muratov FVFTI. Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012;367(25):2375–84. Scholar
  32. 32.
    Patel MR, Calhoon JH, Dehmer GJ, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2017 appropriate use criteria for coronary revascularization in patients with stable ischemic heart disease. J Am Coll Cardiol. 2017;69(17):2212–41. Scholar
  33. 33.
    SCAI-QIT appropriate use criteria app for diagnostic catheterization and coronary revascularization. 2012.Google Scholar
  34. 34.
    Campeau L. Letter: grading of angina pectoris. Circulation. 1976;54(3):522–523. Accessed 29 Oct 2017.
  35. 35.
    Maznyczka A, Sen S, Cook C, Francis DP. The ischaemic constellation: an alternative to the ischaemic cascade-implications for the validation of new ischaemic tests. Open Heart. 2015;2(1):e000178. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of Rochester Medical Center/CardiologyRochesterUSA

Personalised recommendations