Am J Cardiovasc Dis 2013;3(1):27-38

Review Article
Coronary artery disease: to cath or not to cath? When and how best to cath:
those are the remaining questions

Roberta Rossini, Giuseppe Musumeci, Eliano Pio Navarese, Giuseppe Tarantini

USC Cardiologia, Dipartimento Cardiovascolare, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Department of Cardiology
and Internal Medi-cine, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland;
Dipartimento Cardiotoracico, Università di Padova, Italy

Received January 17, 2013; Accepted February 1, 2013; Epub February 17, 2013; Published February 27, 2013

Abstract: Coronary artery disease is the leading cause of death worldwide and it often clinically manifests as stable
angina. The optimal diagnostic and therapeutic strategy of patients with stable angina may be controversial. Coronary
revascularization with percutaneous coronary intervention (PCI) is associated with a reduction in cardiovascular events in
patients with acute coronary syndrome, whereas recent trials have failed to demonstrate the superiority of myocardial
revascularization over optimal medical therapy in stable angina. The treatment of a patient with stable angina is still
challenging, as the definition of “stable” and “unstable” is not so clear. Moreover, the benefit of PCI in terms of quality of life
is evident, and independent from its neutral effect on survival. To date, the best timing of coronary angiography and the role
of further investigations on myocardial ischemia still need to be defined. On the other hand, in spite of the clear benefit on
clinical outcome of an early invasive treatment of patients with acute coronary syndrome, elderly are often undertreated,
whereas the overtreatment with PCI of stable patients undergoing non cardiac surgery might even increase ischemic
events due to the premature discontinuation of the antiplatelet therapy, without reducing the perioperative risk.

Keywords: Coronary artery disease, stable angina, diagnostic and therapeutic strategy, coronary revascularization,
percutaneous coronary intervention (PCI), antiplatelet therapy

Address correspondence to: Dr. Roberta Rossini, USC Cardiologia, Dipartimento Cardiovascolare, Ospedale Papa
Giovanni XXIII, 24127 Ber-gamo Italy. Tel: 00390352673446; Fax: 0039035400491; E-mail:
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