Cost‐effective management of chronic stable angina

AbstractIn certain patients with stable angina who are at moderate to high risk, coronary bypass surgery or coronary angioplasty are the therapeutic options of choice. However, in selected other patients the use of anti‐ischemic drug therapy and secondary prevention reduce episodes of myocardial ischemia and result in a good long‐term prognosis. Factors affecting management include the extent of coronary disease, the magnitude of cardiac symptoms, the severity of myocardial ischemia and of left ventricular function. Based upon these and other clinical characteristics, patients can be divided into low‐, moderate‐, or high‐risk categories for morbidity and mortality. Patients at high risk are more likely to be selected for myocardial revascularization and patients at low risk are often treated with medical therapy, at least initially. Based on the available cost‐effectiveness data, medical therapy or coronary angioplasty are the preferred initial strategies for low‐risk coronary disease, whereas coronary bypass surgery (CABG) is recommended for many high‐risk patients, particularly for those with triple‐vessel disease and impaired left ventricular function or ischemia at a low worklo