Guidelines for the management of patients with chronic stable angina

Treatment

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

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

The dual aims of treating patients with chronic stable angina are 1) to reduce morbidity and mortality and 2) to eliminate angina with minimal adverse effects and allow the patient to return to normal activities. In the absence of contraindications, β-blockers are recommended as initial therapy. All β-blockers seem to be equally effective. If the patient has serious contraindications to β-blockers, unacceptable side effects, or persistent angina, calcium antagonists should be administered. Long-acting dihydropyridine and nondihydropyridine agents are generally as effective as β-blockers in relieving angina. Long-acting nitrates are considered third-line therapy because a nitrate-free interval is required to avoid developing tolerance. All long-acting nitrates seem to be equally effective. Patients with angina should take 75 to 325 mg of aspirin daily unless they have contraindications. Such risk factors as smoking, elevated low-density lipoprotein cholesterol level, diabetes, and hypertension should be treated appropriately. Coronary revascularization has not been shown to improve survival for most patients with chronic angina but may be required to control symptoms. However, coronary artery bypass grafting (CABG) is often indicated for symptomatic patients with left-main disease, three-vessel disease, or two-vessel disease including proximal stenosis of the left anterior descending coronary artery; it improves their survival. Percutaneous transluminal coronary angioplasty is an alternative to CABG for patients with normal left ventricular function and favorable angiographic features. Coronary artery bypass grafting is initially more effective in relieving angina than medical therapy, but the two procedures yield similar results after 5 to 10 years. Eighty percent of patients who undergo CABG remain angina-free 5 years after surgery. In low-risk patients, percutaneous transluminal coronary angioplasty seems to control angina better than medical therapy, but recurrent angina and repeated procedures are more likely than with CABG. Patient education is an important component of management. Long-term follow-up should be individualized to ascertain clinical stability at regular intervals and to reassess prognosis when warranted.

Original languageEnglish (US)
Pages (from-to)616-632
Number of pages17
JournalAnnals of Internal Medicine
Volume135
Issue number8 II
StatePublished - Oct 16 2001
Externally publishedYes

Fingerprint

Stable Angina
Guidelines
Coronary Artery Bypass
Nitrates
Coronary Balloon Angioplasty
Therapeutics
Survival
Patient Education
Left Ventricular Function
LDL Cholesterol
Aspirin
Coronary Vessels
Pathologic Constriction
Smoking
Hypertension
Calcium
Morbidity
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Guidelines for the management of patients with chronic stable angina : Treatment. / Fihn, S. D.; Williams, S. V.; Daley, J.; Gibbons, Raymond J.

In: Annals of Internal Medicine, Vol. 135, No. 8 II, 16.10.2001, p. 616-632.

Research output: Contribution to journalArticle

Fihn, S. D. ; Williams, S. V. ; Daley, J. ; Gibbons, Raymond J. / Guidelines for the management of patients with chronic stable angina : Treatment. In: Annals of Internal Medicine. 2001 ; Vol. 135, No. 8 II. pp. 616-632.
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