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%.
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.
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.
Orsini et al. (Tue,) conducted a 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%.