Why the study?
Recent trials indicate revascularization is not obviously beneficial in stable CAD, prompting a need to review diagnostic pathways, evaluation, timing of revascularization, and medical therapy.
This review synthesizes contemporary evidence, including the ISCHEMIA trial, to recommend a conservative, ischemia-guided approach with optimal medical therapy for stable CAD.
Challenges routine revascularization in stable CAD; leaves open optimal diagnostic pathway refinements.
Coronary artery disease (CAD) remains a leading cause of mortality and morbidity in developed countries. Although urgent revascularization is the cornerstone of management of acute coronary syndrome (ACS), for patients with stable CAD recent large-scale clinical trials indicate that a mechanical 'fix' of a narrowed artery is not obviously beneficial; ACS and stable CAD are increasingly recognized as different clinical entities. We review the perspectives on (1) modifying the diagnostic pathway of stable CAD with the incorporation of modern estimates of pretest probability, (2) non-imaging evaluations based on their availability, (3) the optimal timing of invasive coronary angiography and revascularization, and (4) the implementation of medical therapy during the work-up.
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Kohsaka et al. (2021) studied this question.