Clinical Management of Chronic Stable Angina

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Clinical Management of Chronic Stable Angina
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Anti-ischemic strategies in stable CAD
Initial therapy
Medical therapy PCI CABG
Recurrent ischemia
? Antianginal drug therapy(uptitrate/add new
agents)
Repeat revascularization (if possible)
TMR EECP SCS
TMR transmyocardial revascularization EECP
enhanced external counterpulsation SCS spinal
cord stimulation
Gibbons RJ et al. ACC/AHA 2002 guidelines.
http//www.acc.org/clinical/guidelines/stable/stab
le.pdf.
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Older antianginal drugs Pathophysiologic effects
O2 Demand
O2 Supply
Coronary blood flow
Arterial pressure
Venous return
Myocardial contractility
Heart rate
Drug class
ß-blockers DHP CCBs Non-DHP CCBs Long-acting
nitrates

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Boden WE et al. Clin Cardiol. 20012473-9.
Gibbons RJ et al. ACC/AHA 2002 guidelines.
www.acc.org/clinical/guidelines/stable/stable.pdf
Kerins DM et al. In Goodman and Gilmans The
Pharmacological Basis of Therapeutics. 10th ed.
CCB calcium channel blocker DHP
dihydropyridine Except amlodipine
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Older antianginal drugs Clinical conditions that
may limit use
Treated with PDE5 inhibitors Nondihydropyridine
CCBs
Gibbons RJ et al. ACC/AHA 2002 guidelines.
www.acc.org/clinical/guidelines/stable/stable.pdf
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Unmet needs in antianginal therapy

• Despite medical therapy and/or revascularization,
  some patients continue to experience angina
• Current treatment options for recurrent angina
  are limited
• Consensus on role of newer treatments is pending
• How best to manage symptomatic patients?