The primary goal of therapy in patients with chronic ischaemic heart disease is to relieve symptoms, delay or prevent progression of coronary artery disease, and decrease the risk of major adverse cardiovascular events. This is primarily achieved with optimal medical therapy. When coronary revascularization is considered, symptomatic and prognostic indications must be differentiated. For symptomatic indications, revascularization is justified if there is a large area of inducible ischaemia or if there is persistent limiting angina despite optimal medical therapy. The key prognostic indications for revascularization are left main disease with stenosis greater than 50%, any proximal left anterior descending artery stenosis greater than 50%, two-vessel or three-vessel disease with stenosis greater than 50% with impaired left ventricular function (left ventricular ejection fraction <40%), a large area of ischaemia (>10% of the left ventricle), or a single remaining patent coronary artery with stenosis greater than 50%.
Serial assessment of endothelial vasomotor function using optimal medical therapy predicts clinical outcomes in patients after complete coronary revascularization
