When to use which treatment
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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