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Clinical Management of Chronic Stable Angina

Clinical Management of Chronic Stable Angina. Anti-ischemic strategies in stable CAD. Initial therapy. Medical therapy PCI CABG. Recurrent ischemia.  Antianginal drug therapy (uptitrate/add new agents). Repeat revascularization (if possible). TMR EECP SCS.

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Clinical Management of Chronic Stable Angina

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  1. Clinical Management of Chronic Stable Angina

  2. Anti-ischemic strategies in stable CAD Initial therapy Medical therapy PCI CABG Recurrent ischemia Antianginal drug therapy(uptitrate/add new agents) Repeat revascularization (if possible) TMR EECP SCS TMR = transmyocardial revascularization EECP = enhanced external counterpulsation SCS = spinal cord stimulation Gibbons RJ et al. ACC/AHA 2002 guidelines. http://www.acc.org/clinical/guidelines/stable/stable.pdf.

  3. Older antianginal drugs: Pathophysiologic effects O2 Supply O2 Demand Coronary blood flow Heart rate Arterial pressure Venous return Myocardial contractility Drug class β-blockers DHP CCBs Non-DHP CCBs Long-acting nitrates * / Boden WE et al. Clin Cardiol. 2001;24:73-9.Gibbons RJ et al. ACC/AHA 2002 guidelines. www.acc.org/clinical/guidelines/stable/stable.pdf Kerins DM et al. In: Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th ed. CCB = calcium channel blocker DHP = dihydropyridine *Except amlodipine

  4. Older antianginal drugs: Clinical conditions that may limit use *Treated with PDE5 inhibitors †Nondihydropyridine CCBs Gibbons RJ et al. ACC/AHA 2002 guidelines. www.acc.org/clinical/guidelines/stable/stable.pdf

  5. “Unmet needs” in antianginal therapy • Despite medical therapy and/or revascularization, some patients continue to experience angina • Current treatment options for recurrent angina are limited • Consensus on role of newer treatments is pending • How best to manage symptomatic patients?

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