Treatment of Patients With Stable Ischemic Heart Disease—Reply

• Autores: Sripal Bangalore, David J. Maron, Judith S. Hochman, Tamar S. Polonsky, Ron Blankstein
• Localización: JAMA: the journal of the American Medical Association, ISSN 0098-7484, Vol. 315, Nº. 17, 2016, págs. 1905-1907
• Idioma: inglés
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• Resumen
  • español

    .Drs Civeira and Mateo-Gallego question the referral of a stable patient for CABG surgery. The patient we described had severe myocardial ischemia and more than 70% obstructive disease in all 3 coronary arteries—findings that provide a class I indication for CABG surgery to improve survival.1 Results from trials such as COURAGE and FAME 2 (Fractional Flow Reserve vs Angiography for Multivessel Evaluation 2) demonstrate that many patients with stable ischemic heart disease can be treated with optimal medical therapy alone but do not fully address how to manage the care of patients with severe ischemia.

  • English

    Drs Civeira and Mateo-Gallego point out the contradictory messages between our article and the article by Polonsky et al1 and state that “contradictory messages [on revascularization] may contribute to this important problem [of inappropriate coronary revascularization].” The concern stems from a case described by Polonsky et al of a 53-year-old man with intermediate pretest probability of coronary artery disease and mild angina who had excellent work capacity and low prognostic risk on an ETT but 1.5-mm downsloping ST-segment depressions in multiple leads that began during recovery. He was referred for coronary angiography, found to have multivessel disease, and underwent CABG surgery.