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Stable angina – who needs revascularisation?

Abstract

In the UK, about 5% of men and 3% of women have, or have had, angina.1 Also, estimates suggest that, each year, around 340,000 people present with the symptom for the first time.1 Characterised by pain or discomfort in the chest, angina is usually caused by atherosclerotic coronary artery disease and so carries an increased risk of cardiovascular complications such as myocardial infarction and death from coronary heart disease (CHD). In stable angina, the symptoms are induced by exertion, reflecting the limitation of blood supply through the narrowed arteries and the resulting myocardial ischaemia. The condition is not only potentially distressing, but may also limit daily function and quality of life. To address these problems and the elevated cardiovascular risk, standard management includes lifestyle measures (e.g. physical activity without excessive exertion, stopping smoking, weight control); tackling other cardiovascular risk factors (e.g. raised blood pressure, diabetes mellitus); and medication to control angina (e.g. nitrates, beta-blockers, calcium antagonists) and to reduce overall cardiovascular risk (e.g. aspirin, statin therapy).2,3 Where such non-invasive measures alone are inadequate, revascularisation (restoration of adequate blood supply to the heart muscle) by using coronary artery bypass graft (CABG) surgery or percutaneous coronary intervention (PCI) may also be needed. Here we discuss methods for, and difficulties in, assessing patients who present with suspected stable angina to identify those who could benefit from revascularisation.

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