Medical and Revascularization Management of Stable Ischemic Heart Disease: An Overview

Abstract

Stable ischemic heart disease (SIHD) affects approximately 10 million Americans with 500,000 new cases diagnosed each year. Patients with SIHD are primarily managed in the outpatient setting with aggressive cardiovascular risk factor modification via medical therapy and lifestyle changes. Currently, this approach is considered as the mainstay of treatment. The recently published ISCHEMIA trial has established the noninferiority of medical therapy in comparison to coronary revascularization in patients with moderate to severe ischemia. Percutaneous coronary intervention is currently recommended for patients with significant left main disease, large ischemic myocardial burden, and patients with severe refractory angina despite maximal medical therapy.

Keywords

stable ischemic heart disease - functional flow reserve - medical therapy - primary outcome - intravascular ultrasound - revascularization

Publikationsverlauf

Artikel online veröffentlicht:
21. Januar 2021

• References

• 1 Roger VL, Go AS, Lloyd-Jones DM. et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation 2011; 123 (04) e18-e209
• 2 Patel MR, Dehmer GJ, Hirshfeld JW. et al. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association Tomography. J Am Coll Cardiol 2021; 59: 857-881
• 3 Traub O, Berk BC. Laminar shear stress: mechanisms by which endothelial cells transduce an atheroprotective force. Arterioscler Thromb Vasc Biol 1998; 18 (05) 677-685
• 4 Chiu JJ, Chien S. Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. Physiol Rev 2011; 91 (01) 327-387
• 5 Cheng C, Tempel D, van Haperen R. et al. Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress. Circulation 2006; 113 (23) 2744-2753
• 6 Skålén K, Gustafsson M, Rydberg EK. et al. Subendothelial retention of atherogenic lipoproteins in early atherosclerosis. Nature 2002; 417 (6890): 750-754
• 7 Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JD. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA 2000; 284 (03) 311-318
• 8 Steinbrecher UP, Parthasarathy S, Leake DS, Witztum JL, Steinberg D. Modification of low density lipoprotein by endothelial cells involves lipid peroxidation and degradation of low density lipoprotein phospholipids. Proc Natl Acad Sci U S A 1984; 81 (12) 3883-3887
• 9 Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res 2014; 114 (12) 1852-1866
• 10 Knuuti J, Wijns W, Saraste A. et al; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020; 41 (03) 407-477
• 11 Douglas PS, Hoffmann U, Patel MR. et al; PROMISE Investigators. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med 2015; 372 (14) 1291-1300
• 12 Zacharias K, Ahmed A, Shah BN. et al. Relative clinical and economic impact of exercise echocardiography vs. exercise electrocardiography, as first line investigation in patients without known coronary artery disease and new stable angina: a randomized prospective study. Eur Heart J Cardiovasc Imaging 2017; 18 (02) 195-202
• 13 Fihn SD, Blankenship JC, Alexander KP. et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64 (18) 1929-1949
• 14 Pijls NH, Van Gelder B, Van der Voort P. et al. Fractional flow reserve. A useful index to evaluate the influence of an epicardial coronary stenosis on myocardial blood flow. Circulation 1995; 92 (11) 3183-3193
• 15 Shlofmitz E, Jeremias A. FFR in 2017: Current status in PCI management. Accessed November 27, 2020 at: https://www.acc.org/latest-in-cardiology/articles/2017/05/25/08/34/ffr-in-2017-current-status-in-pci-management
• 16 Tonino PA, De Bruyne B, Pijls NH. et al; FAME Study Investigators. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med 2009; 360 (03) 213-224
• 17 De Bruyne B, Fearon WF, Pijls NH. et al; FAME 2 Trial Investigators. Fractional flow reserve-guided PCI for stable coronary artery disease. N Engl J Med 2014; 371 (13) 1208-1217
• 18 Davies JE, Sen S, Dehbi HM. et al. Use of the instantaneous wave-free ratio or fractional flow reserve in PCI. N Engl J Med 2017; 376 (19) 1824-1834
• 19 Götberg M, Christiansen EH, Gudmundsdottir IJ. et al; iFR-SWEDEHEART Investigators. Instantaneous wave-free ratio versus fractional flow reserve to guide PCI. N Engl J Med 2017; 376 (19) 1813-1823
• 20 Arthurs ZM. The evaluation of peripheral arterial disease with intravascular ultrasound. Vascular Disease Management 2011; 8: E81-E86
• 21 Garcìa-Garcìa HM, Gogas BD, Serruys PW, Bruining N. IVUS-based imaging modalities for tissue characterization: similarities and differences. Int J Cardiovasc Imaging 2011; 27 (02) 215-224
• 22 Cheng JM, Garcia-Garcia HM, de Boer SP. et al. In vivo detection of high-risk coronary plaques by radiofrequency intravascular ultrasound and cardiovascular outcome: results of the ATHEROREMO-IVUS study. Eur Heart J 2014; 35 (10) 639-647
• 23 Schuurman AS, Vroegindewey MM, Kardys I. et al. Prognostic value of intravascular ultrasound in patients with coronary artery disease. J Am Coll Cardiol 2018; 72 (17) 2003-2011
• 24 Stone GW, Maehara A, Lansky AJ. et al; PROSPECT Investigators. A prospective natural-history study of coronary atherosclerosis. N Engl J Med 2011; 364 (03) 226-235
• 25 Dahl Aarvik M, Sandven I, Dondo TB. et al. Effect of oral β-blocker treatment on mortality in contemporary post-myocardial infarction patients: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother 2019; 5 (01) 12-20
• 26 Padala SK, Lavelle MP, Sidhu MS. et al. Antianginal therapy for stable ischemic heart disease: a contemporary review. J Cardiovasc Pharmacol Ther 2017; 22 (06) 499-510
• 27 Motivala AA, Parikh V, Roe M. et al. Predictors, trends, and outcomes (among older patients ≥65 years of age) associated with beta-blocker use in patients with stable angina undergoing elective percutaneous coronary intervention: insights from the NCDR registry. JACC Cardiovasc Interv 2016; 9 (16) 1639-1648
• 28 Sorbets E, Steg PG, Young R. et al; CLARIFY investigators. β-blockers, calcium antagonists, and mortality in stable coronary artery disease: an international cohort study. Eur Heart J 2019; 40 (18) 1399-1407
• 29 Wei J, Wu T, Yang Q, Chen M, Ni J, Huang D. Nitrates for stable angina: a systematic review and meta-analysis of randomized clinical trials. Int J Cardiol 2011; 146 (01) 4-12
• 30 CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996; 348 (9038): 1329-1339
• 31 Bhatt DL, Fox KAA, Hacke W. et al; CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 2006; 354 (16) 1706-1717
• 32 Bonaca MP, Bhatt DL, Cohen M. et al; PEGASUS-TIMI 54 Steering Committee and Investigators. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015; 372 (19) 1791-1800
• 33 Eikelboom JW, Connolly SJ, Bosch J. et al; COMPASS Investigators. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 2017; 377 (14) 1319-1330
• 34 Choi JY, Na JO. Pharmacological strategies beyond statins: ezetimibe and PCSK9 inhibitors. J Lipid Atheroscler 2019; 8 (02) 183-191
• 35 Cannon CP, Blazing MA, Giugliano RP. et al; IMPROVE-IT Investigators. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372 (25) 2387-2397
• 36 Adhyaru BB, Jacobson TA. Role of non-statins, LDL-C thresholds, and special population considerations: a look at the updated 2016 ACC Consensus Committee Recommendations. Curr Atheroscler Rep 2017; 19 (06) 29
• 37 Silverman MG, Ference BA, Im K. et al. Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis. JAMA 2016; 316 (12) 1289-1297
• 38 Bethel MA, Patel RA, Merrill P. et al; EXSCEL Study Group. Cardiovascular outcomes with glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes: a meta-analysis. Lancet Diabetes Endocrinol 2018; 6 (02) 105-113
• 39 Zelniker TA, Wiviott SD, Raz I. et al. SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a systematic review and meta-analysis of cardiovascular outcome trials. Lancet 2019; 393 (10166): 31-39
• 40 Zinman B, Wanner C, Lachin JM. et al; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373 (22) 2117-2128
• 41 Fitchett D, Zinman B, Wanner C. et al; EMPA-REG OUTCOME® trial investigators. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® trial. Eur Heart J 2016; 37 (19) 1526-1534
• 42 McMurray JJV, Solomon SD, Inzucchi SE. et al; DAPA-HF Trial Committees and Investigators. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med 2019; 381 (21) 1995-2008
• 43 Maron DJ, Hochman JS, Reynolds HR. et al; ISCHEMIA Research Group. Initial invasive or conservative strategy for stable coronary disease. N Engl J Med 2020; 382 (15) 1395-1407
• 44 Radaideh Q, Osman M, Kheiri B. et al. Meta-analysis of the effect of percutaneous coronary intervention on death and myocardial infarction in patients with stable coronary artery disease and inducible myocardial ischemia. Am J Cardiol 2020; 133: 171-174
• 45 Katritsis DG, Mark DB, Gersh BJ. Revascularization in stable coronary disease: evidence and uncertainties. Nat Rev Cardiol 2018; 15 (07) 408-419
• 46 Sianos G, Morel MA, Kappetein AP. et al. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention 2005; 1 (02) 219-227
• 47 Mohr FW, Morice MC, Kappetein AP. et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381 (9867): 629-638
• 48 Frye RL, August P, Brooks MM. et al; BARI 2D Study Group. A randomized trial of therapies for type 2 diabetes and coronary artery disease. N Engl J Med 2009; 360 (24) 2503-2515
• 49 Xaplanteris P, Fournier S, Pijls NHJ. et al; FAME 2 Investigators. Five-year outcomes with PCI guided by fractional flow reserve. N Engl J Med 2018; 379 (03) 250-259