1. Contemporary Management of Stable Coronary Artery Disease ― Implications of the ISCHEMIA Trial ―
- Author
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Mitsuaki Sawano, Susumu Manabe, Ippei Watanabe, Kenji Fukushima, Shun Kohsaka, Nozomi Niimi, Yodo Gatate, and Shintaro Nakano
- Subjects
medicine.medical_specialty ,Acute coronary syndrome ,medicine.medical_treatment ,Ischemia ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Revascularization ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Acute Coronary Syndrome ,Clinical Trials as Topic ,Management of acute coronary syndrome ,business.industry ,General Medicine ,medicine.disease ,Clinical trial ,Pre- and post-test probability ,medicine.anatomical_structure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Artery - Abstract
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.
- Published
- 2021
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