A. Stable Angina
If stable angina is not adequately relieved by the combi¬nation of a beta-blocker, a nitrate, and a calcium blocker and lifestyle is deemed unacceptable by the patient or the physician, coronary artery bypass surgery is usually recommended. The main aim of surgery is to relieve pain. The complete relief of pain is certainly most satisfying and this is achieved in 90% of patients, whereas drugs achieve this goal in less than 50%. Drugs lessen the frequency of angina by about 60% in approximately 60% of patients treated. Some patients are satisfied with medical therapy and surgery is not indicated. About 40% of patients with angina are not satisfactorily controlled with medical ther¬apy; these patients are recommended to have coronary arteriography with a view to CABG.
Patients with mild anginal symptoms may have severe atheromatous obstruction of the coronary arteries. Stress testing and nuclear scans may risk-stratify these patients; those with positive tests at a workload that is low are usually submitted to coronary arteriography.
Patients with mild stable angina with compromised left ventricular function as indicated by an ejection fraction (EF) of less than 45% and patients with diabetes may obtain improvement in survival with a revascularization procedure. The revascularization procedure may be bypass surgery or PCI. In addition, beta-blockers are contra-indicated in patients with asthma and they may require revascularization at an early stage.

Страницы: 1 | 2