Chronic stable angina: percutaneous coronary intervention or medication?

C oronary artery disease is a worldwide hazard today and stable angina is one of its commonest manifestations. The diagnosis of chronic stable angina is based on the presence of anginal symptoms, a positive exercise test for myocardial ischaemia, and confirmation of coronary artery atherosclerosis by coronary angiography. However, the optimum treatment of these patients has been a controversial issue in recent years. Recent studies, or meta-analyses thereof, have still not fully determined the usefulness of invasive treatment of the coronary arteries with percutaneous coronary intervention (PCI) in comparison with medication. While PCI is known to reduce the incidence of death and myocardial infarction in patients who suffer from acute coronary syndromes, the same benefit does not appear to extend to patients who have stable coronary artery disease. As the availability of non-invasive methods of diagnosing coronary artery disease steadily increases, asymptomatic patients are often referred for PCI. However, a necessary condition for any preventive therapy is that it should combat a threat —which in the case of stable coronary artery disease is acute myocardial infarction and death— with an acceptable cost. Review of relevant published studies