Key result
A tailored approach to stable angina with initial medical therapy followed by selective revascularization resulted in a low 1-year MACE rate of 2.9%.
Why the study?
Clinical outcomes of stable angina patients managed according to guideline recommendations—medical therapy first, followed by selective revascularization in high-risk or unresponsive patients—were not fully known.
Does a guideline-directed strategy of initial medical therapy with selective revascularization improve outcomes and symptoms in patients with newly diagnosed stable angina?
Observational (n=833)
Yes
Does a guideline-directed strategy of initial medical therapy with selective revascularization improve outcomes and symptoms in patients with newly diagnosed stable angina?
A guideline-directed approach of initial medical therapy followed by selective revascularization is safe and effective for managing newly diagnosed stable angina, yielding low MACE rates and significant symptom improvement.
Supports initial medical therapy with selective revascularization in stable angina; hypothesis-generating and requires RCTs before practice change.
BACKGROUND: Clinical outcomes of stable angina patients treated according to guidelines recommendations (medical therapy first, selective revascularization in high risk or unresponsive patients) are not fully known. METHODS AND RESULTS: Eight hundred thirty-three patients with newly diagnosed, stable angina were enrolled in a prospective, observational, nationwide registry and followed for 1 year. Symptoms and quality of life were evaluated with the CCS angina grading, with a self-assessment scale and with the SAQ-7. A composite end-point of MACEs (all-cause death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for unstable angina) at 1 year was considered. Upon enrollment, all patients were prescribed guidelines directed medical therapy. After one month of therapy, angina relieved or improved in 47% of the overall population. Patients in CCS class I significantly increased from 28.4% at enrollment to 67.1% at 12 months, and the SAQ-7 score from 58.4 ± 20 to 85.9 ± 14. The rate of MACEs was low (2.9%) in the overall population. After one month of medical therapy, 40.6% of patients were referred for coronary angiography and revascularization for resistant symptoms (invasive strategy). Among these, 38.2% had normal coronary arteries and 47% actually underwent revascularization. No difference between invasive and medical groups was found at 12 months in symptoms, quality of life and MACEs, except for a greater improvement in self-assessed symptoms in the invasive group. Combined medical and invasive strategies left 28.5% of patients still symptomatic at the end of the study. CONCLUSIONS: The study confirms the efficacy and safety of a tailored approach to stable angina, as recommended by guidelines, with medical therapy first followed by selective revascularization when needed.
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Orsini et al. (2022) conducted an observational in newly diagnosed, stable angina (n=833). Guidelines directed medical therapy with selective revascularization was evaluated on Composite of MACEs (all-cause death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for unstable angina) at 1 year. A tailored approach to stable angina with initial medical therapy followed by selective revascularization resulted in a low 1-year MACE rate of 2.9%.
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