When to use which treatment
Investigators from Georgetown University Medical Center in Washington used MEDLINE to review data on the treatment of chronic stable angina so they could devise a reasonable approach to when to use pharmacologic therapy, angioplasty, or bypass surgery.1
What they came up with is that for low-risk patients, a strategy of initial medical therapy works best. Low-risk patients with single-vessel coronary artery disease and normal left ventricular function had greater alleviation of symptoms with angioplasty than with medical treatment, and mortality and rates of infarction were unchanged.
In moderate-risk patients - those with multivessel disease and normal left ventricular function - angioplasty and bypass surgery produce similar mortality statistics and rates of MI; angioplasty patients require more revascularization procedures.
Bypass surgery is generally best for high-risk patients, defined by severity of ischemia, number of diseased vessels, and presence of left ventricular dysfunction.
Reference
1. Solomon AJ, Gersh BJ. Management of chronic stable angina: Medical therapy, percutaneous transluminal coronary angioplasty, and coronary artery bypass graft surgery. Ann Intern Med 1998;128:216-223.
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