Therapeutic approach in patients with stable angina.

Which therapeutic strategy among medical, interventional and surgical options should be preferred in patients with chronic stable ischemic heart disease is an important public health problem. The available scientific evidence does not help much to facilitate the choice among the three available strategies of medical treatment, percutaneous coronary intervention and coronary artery bypass grafting. In this area practice-based medicine overwhelms evidence-based medicine. However, existing findings are discussed. The present experience in diabetic patients is highlighted; in such patients surgery is generally recommended but the results obtained by percutaneous coronary intervention with the currently available tools are improving markedly. Pharmacological therapy is also improving, particularly in the prevention of the progression of atherothrombosis and consequently of cardiovascular events. Actually two categories of drugs should be recognized: those prescribed to prevent death and myocardial infarction and those with antianginal and anti-ischemic effects aimed at alleviating symptoms and reducing ischemia. The first group of drugs includes antiplatelet-antithrombotic agents, lipid-lowering agents and angiotensin-converting enzyme inhibitors; the second group includes beta-blockers, calcium antagonists and nitrates. A good integration of the two classes of drugs, combined with an appropriate use of coronary revascularization procedures, should yield the maximum possible benefit in the individual patient.