Ischemic heart disease: A patient-specific therapeutic approach with emphasis on quality of life considerations

https://doi.org/10.1016/0002-8703(87)90974-4Get rights and content

Abstract

Advantages and disadvantages of the various therapies for stable angina are considered with particular attention to quality of life. Advantages of coronary artery bypass surgery (CABS), apart from the question of survival, include less angina, less activity limitation, and less need for drugs than with medical treatment. However, data from the Coronary Artery Surgery Study (CASS) and others show that there is no difference between medical and surgical therapy in return to work and in need for subsequent hospitalization. In CABS patients, there is also predictable return of angina, substantial late vein graft occlusion, and possibly increased progression of native coronary artery disease in grafted vessels. Percutaneous transiuminal coronary angioplasty (PTCA) has advantages similar to those of CABS, with very low initial mortallty and major complication rates, minimal discomfort, very short disability period, and moderate cost. Its major disadvantages are a high short-term reocclusion rate and uncertain long-term outcome. Beta blockers provide good control of angina, have additional antihypertensive and antiarrhythmic effects, and may be beneficial in preventing sudden cardiac (arrhythmic) death and limiting myocardial infarct size, should these events supervene in the patient with angina. Disadvantages of beta blockers involve the occasional major side effects, including potential exacerbation of bronchospasm, peripheral vascular disease (PVD), diabetes, congestive heart failure and bradyarrhythmia, and frequent “nuisance” side effects. Calcium blockers control both exercise and rest angina and pose no problem in patients with bronchoconstriction, PVD, or diabetes. Disadvantages include need for frequent dosage, cost, and side effects. Long-acting nitrates have few major side effects and usually transient minor side effects, with little effect on quality of life. The major questions involving long-acting nitrates, particularly transdermal nitroglycerin (TD-NTG), concern efficacy and attenuation. A number of trials of TD-NTG have evaluated objective exercise tolerance; several have demonstrated significant increases in exercise time 4 to 24 hours after TD-NTG application.

References (21)

There are more references available in the full text version of this article.

Cited by (13)

  • Popular procedures without evidence of benefit: A case study of percutaneous coronary intervention for stable coronary artery disease

    2021, European Journal of Internal Medicine
    Citation Excerpt :

    Notably, there was no control arm, comparison to medical therapy, nor measured outcomes past nine months post-intervention. Despite the lack of an randomized control trial showing evidence of efficacy, PCI is ubiquitous in the treatment of CAD and has been argued to provide symptomatic relief for these patients [8-10]. In this article, we first review the primary evidence on optimal medical therapy and PCI for patients with stable CAD.

  • Uncertainty and psychologic stress after coronary angioplasty and coronary bypass surgery

    1995, Heart and Lung - The Journal of Acute and Critical Care
View all citing articles on Scopus
View full text