Guidelines for the management of patients with chronic stable angina: Diagnosis and risk stratification

S. V. Williams, S. D. Fihn, Raymond J Gibbons

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

Patients with suspected chronic stable angina can be evaluated in three stages. In stage one, the clinician uses information from the history, physical examination, laboratory tests for diabetes and hyperlipidemia, and resting electrocardiography to estimate the patient's probability of coronary artery disease (CAD). In stage two, additional testing for patients with a low probability of CAD focuses on diagnosing noncoronary causes of chest pain. Patients with a high probability of CAD have stress tests to assess their risk from CAD, and patients with an intermediate probability of CAD have stress tests to estimate the probability of CAD and assess their risk from CAD. Most patients with new-onset angina can start stress testing with exercise electrocardiography. The initial stress test should be a stress imaging procedure for patients with rest ST-segment depression greater than 1 mm, complete left bundle-branch block, ventricular paced rhythm, preexcitation syndrome, or previous revascularization with percutaneous coronary angioplasty or coronary artery bypass grafting. Patients who cannot exercise can have an imaging procedure with stress induced by pharmacologic agents. In stage three, patients with a predicted average annual cardiac mortality rate between 1% and 3% should have a stress imaging study or coronary angiography with left ventriculography. Those with a known left ventricular dysfunction should have cardiac catheterization. Patients with CAD who have an estimated annual mortality rate greater than 3% should have cardiac catheterization to determine whether their anatomy is suitable for revascularization. Patients with an estimated annual mortality rate less than 1% can begin to receive medical therapy.

Original languageEnglish (US)
Pages (from-to)530-547
Number of pages18
JournalAnnals of Internal Medicine
Volume135
Issue number7
StatePublished - Oct 2 2001
Externally publishedYes

Fingerprint

Stable Angina
Guidelines
Coronary Artery Disease
Exercise Test
Cardiac Catheterization
Mortality
Electrocardiography
Pre-Excitation Syndromes
Exercise
Bundle-Branch Block
Left Ventricular Dysfunction
Percutaneous Coronary Intervention
Hyperlipidemias
Coronary Angiography
Chest Pain
Angioplasty
Coronary Artery Bypass
Physical Examination
Anatomy
History

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Guidelines for the management of patients with chronic stable angina : Diagnosis and risk stratification. / Williams, S. V.; Fihn, S. D.; Gibbons, Raymond J.

In: Annals of Internal Medicine, Vol. 135, No. 7, 02.10.2001, p. 530-547.

Research output: Contribution to journalArticle

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