Strategies in Stable Chronic Coronary Disease

  • David Corcoran
  • Damien Collison
  • Tom Ford
  • Colin Berry
Chapter

Abstract

Stable coronary artery syndromes include patients with angina caused by obstructive coronary artery disease, by a disorder of coronary vascular function, or by a combination of these two clinical entities. The diagnostic pathway in patients presenting with chest pain and suspected stable coronary artery disease (SCAD) can be challenging because of variations in the pre-test probability of CAD and in the accuracy and local availability of diagnostic tests. There is uncertainty regarding the comparative effectiveness of non-invasive imaging-based diagnostic strategies for the detection of CAD and their role in directing ongoing management. In this chapter, we review the evidence base and clinical practice guideline recommendations underpinning non-invasive and invasive diagnostic strategies.

Optimal medical therapy (OMT) forms the cornerstone of treatment of SCAD. Nevertheless, myocardial revascularisation reduces ischaemia and improves symptoms to a greater extent than OMT alone. In contrast to revascularisation in the context of acute coronary syndromes, randomised controlled trials of revascularisation in SCAD have not demonstrated a mortality benefit. Revascularization decisions must take into account the totality of clinical data, namely, the coronary anatomy, patient-specific clinical factors such as age and co-morbidity, and the feasibility of complete revascularisation. We discuss the key evidence and clinical practice guideline recommendations for myocardial revascularisation of patients with SCAD.

Finally, we describe the conundrum of patients presenting with angina and no obstructive CAD. We discuss the requirement for a comprehensive invasive assessment of coronary physiology in these patients to clarify the diagnosis and to direct ongoing care.

Keywords

Stable coronary artery disease Angina Optimal medical therapy Revascularisation PCI CABG Ischaemia Microvascular 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • David Corcoran
    • 1
    • 2
  • Damien Collison
    • 1
    • 2
  • Tom Ford
    • 1
    • 2
  • Colin Berry
    • 1
    • 2
  1. 1.West of Scotland Heart and Lung Centre, Golden Jubilee National HospitalClydebankUK
  2. 2.British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of GlasgowGlasgowUK

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