Contemporary Management of Stable Coronary Artery Disease - Implications of the ISCHEMIA Trial -

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.

Automated summary

Coronary artery disease remains a major cause of mortality and morbidity in developed countries. While urgent revascularization is critical for acute coronary syndrome management, recent large-scale clinical trials suggest that mechanically 'fixing' a narrowed artery may not be clearly beneficial for stable CAD patients. Differentiating between ACS and stable CAD is important for modifying diagnostic pathways, non-imaging evaluations, optimal timing for invasive coronary angiography and revascularization, and implementing medical therapy during the work-up.