Stable ischemic heart disease: re-appraisal of coronary revascularization criteria in the light of contemporary evidence

Abstract

The term "stable ischemic heart disease" includes a variety of clinical and pathophysiological situations resulting in different presentation modalities, often with complex referral patterns, and with multiple potential therapeutical options. Multifactorial pathogenesis and multiform expressivity are poorly captured by the traditional vision of ischemic heart disease (IHD) as the clogged pipes disease. The availability of different technologies for studying patients with symptoms suggestive of IHD, has shed a new light on the pathophysiology of the disease, but has also allowed appropriate follow-up of patients allocated to different therapeutical options. Though coronary revascularization has been one primary treatment option for obstructive coronary artery disease (CAD), the evidence for its efficacy in patients without acute presentation is far from optimal. A number of studies and meta-analyses strongly support the need for a personalized and optimized medical approach (including functional assessment and therapy) before the tailored option of revascularization in selected patients, in order to optimize its effects on symptoms and outcome. Most recent data have expanded the need for a more personalised approach to this complex situation, which should be patient-centered and not focused on technologies. In this review, we discuss the major pathophysiological factors and the most recent clinical data and guidelines suggestions, needed for a critical re-appraisal of the clinical decision-making to perform revascularization in patients with stable IHD.Moreover we aimed at suggesting the potential role for future studies to fill the existing knowledge gaps but also to counteract a reductive, hydraulic view of chronic IHD, which seems to be still alive and kicking, both in clinical and research communities, despite multiple evidences and recommendations.

Exploring the effect of self-efficacy enhancement program on medication adherence and self-efficacy among patients with acute coronary syndrome

“…It accounts for 46% of all deaths in Iran (2). Ischemic heart disease includes a range of diseases, including stable angina and ACS (such as unstable angina and myocardial infarction with or without ST-segment elevation) and imposes a high financial burden on individuals and communities due to its severe longterm complications (3). The ideal treatment for this disease involves the use of several measures including drugs, interventions, surgery, risk factor control, and lifestyle modification (4).…”

Clinical outcomes of newly diagnosed, stable angina patients managed according to current guidelines. The ARCA (Arca Registry for Chronic Angina) Registry: A prospective, observational, nationwide study

“…ARCA Registry is a prospective, observational, nationwide study designed and conducted by the Italian Scientific Society A.R.C.A. (Associazioni Regionali Cardiologi Ambulatoriali) with the purpose to collect information on: severity of symptoms and quality of life in newly diagnosed, stable angina patients treated according to guidelines recommendations; prevalence of refractory angina; prevalence of coronary anatomy suitable for revascularization in patients with refractory angina; MACEs within one year from study inclusion [9].…”