Medical Therapy With Versus Without Revascularization in Stable Patients With Moderate and Severe Ischemia: The Case for Community Equipoise

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• 作者：Gregg W. Stone ; MD^&lowast ; ; ^{gs2184@columbia.edu" class="auth_mail" title="E-mail the corresponding author} ; Judith S. Hochman ; MD^&dagger ; ; David O. Williams ; MD^&Dagger ; ; William E. Boden ; MD^§ ; ; T. Bruce Ferguson Jr. ; MD^‖ ; Robert A. Harrington ; MD^¶ ; ; David J. Maron ; MD^¶ ;
• 关键词：angina pectoris ; coronary artery bypass ; coronary artery disease ; guideline-directed medical therapy ; percutaneous coronary intervention
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：5-12 January 2016
• 年：2016
• 卷：67
• 期：1
• 页码：81-99
• 全文大小：1115 K

文摘

All patients with stable ischemic heart disease (SIHD) should be managed with guideline-directed medical therapy (GDMT), which reduces progression of atherosclerosis and prevents coronary thrombosis. Revascularization is also indicated in patients with SIHD and progressive or refractory symptoms, despite medical management. Whether a strategy of routine revascularization (with percutaneous coronary intervention or coronary artery bypass graft surgery as appropriate) plus GDMT reduces rates of death or myocardial infarction, or improves quality of life compared to an initial approach of GDMT alone in patients with substantial ischemia is uncertain. Opinions run strongly on both sides, and evidence may be used to support either approach. Careful review of the data demonstrates the limitations of our current knowledge, resulting in a state of community equipoise. The ongoing ISCHEMIA trial (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) is being performed to determine the optimal approach to managing patients with SIHD, moderate-to-severe ischemia, and symptoms that can be controlled medically. (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches [ISCHEMIA]; NCT01471522)