What is considered to be the optimal treatment for stable angina in the year 2012?

摘要

Optimal treatment of stable angina consists of abolishing of or reduction of angina attacks,improvement of quality of life, and prevention of serious adverse clinical outcomes such as acute coronarysyndrome, cardiac death, and heart failure. Several old and effective medications (beta-blockers, long and shortacting nitrates, and calcium channel blockers) and new novel agents (trimetazadine, ranolazine, ivabradine)ameliorate angina, improve exercise tolerance and exert anti-ischemic effects; but none have been shown toprolong life or prevent the occurrence of a myocardial infarction (MI) in patients with stable angina. Coronaryartery revascularization also provides symptomatic relief, but does not improve survival or reduce the incidenceof MI compared to medical treatment. Aspirin and HMG co-reductase inhibitors (statins) have been shown toimprove survival and reduce the occurrence of MI. Cessation of smoking and better control of blood pressureand exercise rehabilitation improves symptoms and may reduce serious adverse outcomes. In patients with stableangina, who have reduced LV function, or a history of a recent MI, beta-blockers, ACE-inhibitors andaldosterone receptor antagonists are indicated as these medications improve survival. Polytherapy is oftenneeded. If medications do not alleviate symptoms, either percutaneous or surgical coronary arteryrevascularization should be considered for symptom relief. Individualized approach is needed to achieve theabove goals.