Chronic Stable Angina

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  • Drug therapy has been the primary treatment for stable angina since nitroglycerin was first used in 1878. However, since percutaneous coronary intervention was introduced, the role of PCI in patients with stable coronary artery disease (CAD) has been the subject of much study.

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    Drug therapy has been the primary treatment for stable angina since nitroglycerin was first used in 1878. However, since percutaneous coronary intervention was introduced, the role of PCI in patients with stable coronary artery disease (CAD) has been the subject of much study.

    Current guidelines recommend percutaneous coronary intervention (PCI) in patients with ongoing stable angina symptoms despite optimal medical therapy (OMT), although trials have shown no reduction in death or MI. The recent ORBITA trial compared OMT and PCI with OMT and ‘placebo’ PCI in patients with angina and single-vessel CAD, and found no significant difference in treadmill exercise time between the two groups after 6 weeks. However, ORBITA does not add to the current evidence base supporting ischaemia-guided revascularisation if symptoms are not controlled on medical therapy alone, and further trials are needed

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