STABLE ISCHEMIC HEART DISEASE: EVOLVING CONCEPTS AND THE ROLE OF ISCHEMIA


Mandeep S. Sidhu, M.D., Albany Medical College, Albany, NY, USA

The optimal strategy for the management of patients with stable ischemic heart disease (SIHD) has been a matter of considerable debate over the past two decades. During this time period, there have been notable technologic evolutions in catheter-based revascularization that include the advent of bare metal and drug-eluting stents, the genesis of more effective antiplatelet therapy, the continued refinement of stent delivery platforms, improving operator experience and quality improvement initiatives which have led to declining complication rates. As a result, the approach to the management of SIHD has shifted increasingly from an initial pharmacologic strategy to one that embraces an initial percutaneous coronary intervention (PCI) approach. However, such a management paradigm is not fully supported by robust outcomes data, which suggests the need for a critical reappraisal of contemporary clinical practice. In particular, clinical decision-making is now better informed because of the results of several important randomized control trials that have rigorously compared the hard clinical endpoints of death and myocardial infarction (MI) in patients with SIHD who have undergone PCI with contemporary, guideline-directed medical therapy combined with lifestyle intervention.