clinical management of chronic stable angina l.
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Clinical Management of Chronic Stable Angina. 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.

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anti ischemic strategies in stable cad
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/stable.pdf.

older antianginal drugs pathophysiologic effects
Older antianginal drugs: Pathophysiologic effects

O2 Supply

O2 Demand

Coronary

blood flow

Heart

rate

Arterial

pressure

Venous

return

Myocardial

contractility

Drug class

β-blockers

DHP CCBs

Non-DHP CCBs

Long-acting nitrates

*

/

Boden WE et al. Clin Cardiol. 2001;24:73-9.Gibbons RJ et al. ACC/AHA 2002 guidelines. www.acc.org/clinical/guidelines/stable/stable.pdf

Kerins DM et al. In: Goodman and Gilman’s The Pharmacological Basis of Therapeutics. 10th ed.

CCB = calcium channel blocker

DHP = dihydropyridine

*Except amlodipine

older antianginal drugs clinical conditions that may limit use
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

unmet needs in antianginal therapy
“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?