scholarly journals ORBITA: What Goes Around, Comes Around… Or Does It?

2018 ◽  
Vol 13 (3) ◽  
pp. 135
Author(s):  
Matthew Jackson ◽  
Azfar Zaman ◽  
◽  
Keyword(s):  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Current Evidence ◽  
Placebo Control ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Current Evidence Base ◽  
Artery Disease

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 myocardial infarction. The recently published ORBITA trial compared OMT + PCI with OMT + ‘placebo’ PCI in patients with angina and single-vessel coronary artery disease (CAD), and found no significant difference in treadmill exercise time between the two groups after six weeks. The trial concluded that invasive procedures can be assessed with placebo control while numerous editorials interpreted the trial as showing that PCI has no role in the management of stable angina. However, the highly selected patient population, low ischaemic burden and level of symptoms and high proportion of nonflow-limiting stenoses on invasive physiological testing mean that, while ground-breaking in terms of its methodology, ORBITA does not add to the current evidence base supporting ischaemia-guided revascularisation if symptoms are not controlled on medical therapy alone.

Immediate post-procedural functional assessment of percutaneous coronary intervention: current evidence and future directions

2021 ◽  
Author(s):  
Daixin Ding ◽  
Jiayue Huang ◽  
Jelmer Westra ◽  
David Joel Cohen ◽  
Yundai Chen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Functional Assessment ◽  
Functional Results ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Current Evidence ◽  
Cardiac Events ◽  
Percutaneous Coronary ◽  
Current Evidence Base

Abstract Percutaneous coronary intervention (PCI) guided by coronary physiology provides symptomatic benefit and improves patient outcomes. Nevertheless, over one-fourth of patients still experience recurrent angina or major adverse cardiac events following the index procedure. Coronary angiography, the current workhorse for evaluating PCI efficacy, has limited ability to identify suboptimal PCI results. Accumulating evidence supports the usefulness of immediate post-procedural functional assessment. This review discusses the incidence and possible mechanisms behind a suboptimal physiology immediately after PCI. Furthermore, we summarize the current evidence base supporting the usefulness of immediate post-PCI functional assessment for evaluating PCI effectiveness, guiding PCI optimization, and predicting clinical outcomes. Multiple observational studies and post hoc analyses of datasets from randomized trials demonstrated that higher post-PCI functional results are associated with better clinical outcomes as well as a reduced rate of residual angina and repeat revascularization. As such, post-PCI functional assessment is anticipated to impact patient management, secondary prevention, and resource utilization. Pre-PCI physiological guidance has been shown to improve clinical outcomes and reduce health care costs. Whether similar benefits can be achieved using post-PCI physiological assessment requires evaluation in randomized clinical outcome trials.

scholarly journals Total angiographic regression of coronary atherosclerosis with optimal medical therapy

2019 ◽  
Vol 12 (11) ◽  
pp. e230456
Author(s):  
Kudel Kunhali ◽  
Robin George Manappallil
Keyword(s):  
Medical Therapy ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Lifestyle Changes ◽  
Optimal Medical Therapy ◽  
First Line ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Therapeutic Lifestyle Changes ◽  
Current Guidelines

Coronary artery disease has shown a dramatic increase worldwide. According to the current guidelines, optimal medical therapy (OMT) is recommended as the first-line treatment for stable angina; with revascularisation being reserved for those with persistent or progressive symptoms despite intensive medical therapy. We report the case of a young man with stable angina, who was advised percutaneous coronary intervention for stenosis of left anterior descending artery. As he was not willing for the same, he was treated with OMT (according to the then relevant Adult Treatment Panel (ATP) III guidelines) and therapeutic lifestyle changes, following which he became asymptomatic along with total regression of the atherosclerotic plaque on coronary angiogram. This case highlights that OMT can be an effective line of management in patients with stable angina; and interventions like angioplasty, stents and surgery may be reserved for those who do not respond adequately.

Chronic Stable Angina

2017 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

scholarly journals Bivalirudin in the Treatment of Coronary Artery Disease

2014 ◽  
Vol 5 (2) ◽  
pp. 67-80
Author(s):  
Rohan Jayasinghe ◽  
Ryan Maxwell ◽  
Vaishnavi Sridhar
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Myocardial Infarctions ◽  
Percutaneous Coronary ◽  
Coronary Syndromes ◽  
St Elevation ◽  
Artery Disease

Periprocedural anticoagulation continues to be a vital aspect in the management of coronary artery disease. Bivalirudin is a relatively new drug that has caught much attention in the last decade, especially in the context of percutaneous coronary intervention for acute coronary syndromes. Multiple clinical trials have shown the efficacy, safety profile and limitations of bivalirudin in contrast to previously used heparin and glycoprotein IIb/IIIa inhibitors. These trials have included patients with moderate to high-risk stable angina, unstable angina, non-ST-elevation and ST-elevation myocardial infarctions requiring PCI. The growing body of evidence on bivalirudin has also improved the understanding of its applicability and efficacy over other hirudin-based anticoagulants, however continual review of more recent evidence is important in order to integrate bivalirudin more widely across the various guidelines. This article aims to study the cross-section of the evidence base to date on the clinical use, efficacy and risks related to the use of bivalirudin and attempts to provide the clinician with a practical overview of the role of bivalirudin in the most recent guidelines.

Chronic Stable Angina

2015 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 12 tables, and 109 references.

Chronic Stable Angina

2018 ◽  
Author(s):  
Benjamin J Scirica ◽  
J. Antonio T. Gutierrez
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
Coronary Artery ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Artery Disease

By definition, chronic stable angina is angina that has been stable with regard to frequency and severity for at least 2 months. Chronic stable angina is the initial manifestation of coronary heart disease in approximately 50% of patients. Typically, this type of angina occurs in the setting of atherosclerotic coronary arterial narrowing, although other causes are possible. This review covers the epidemiology, pathophysiology, initial evaluation, differential diagnosis, management, and treatment of patients with chronic stable angina. Figures show noninvasive testing and the probability of coronary artery disease; diagnosis of patients with suspected ischemic heart disease; probability of severe coronary artery disease; coronary outcomes for high- versus low-intensity statin therapy; optimal medical therapy (OMT) versus OMT and percutaneous coronary intervention for chronic angina; OMT versus percutaneous coronary intervention for stable coronary heart disease; and coronary artery bypass grafting versus percutaneous coronary intervention for diabetes and coronary artery disease. Tables list the grading of angina pectoris by the Canadian Cardiovascular Society classification system, the differential diagnosis of chest pain, conditions promoting myocardial oxygen supply and demand mismatch, the features of typical angina, the classification of chest pain, a comparison of the pretest likelihood of coronary heart disease (CHD) in low-risk and high-risk symptomatic patients, the posttest probability of significant CHD based on pretest probabilities of CHD and normal or abnormal results of noninvasive studies, survival according to risk groups based on Duke treadmill scores, high- and moderate-intensity statin therapy, revascularization to improve survival compared with medical therapy, revascularization to improve symptoms with significant anatomic (≥ 50% left main or ≥ 70% nonleft main coronary artery disease) or physiologic (fractional flow reserve ≤ 0.80) coronary artery stenoses, and questions recommended by an expert panel for patients with chronic stable angina at follow-up visits. This review contains 7 highly rendered figures, 13 tables, and 109 references.

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