CHRONIC STABLE ANGINA-PECTORIS - STRATEGIES FOR EFFECTIVE DRUG-THERAPY

In most patients with stable angina pectoris, severe eccentric atheros clerotic narrowing of coronary arteries is responsible for chest pain and myocardial ischemia. If myocardial infarction or death occurs, it is usually the consequence of a ruptured plaque. About 10% to 20% of p atients with stable angina have normal coronary arteries,(6) and their long-term prognosis is excellent. In patients with angina secondary t o atherosclerotic lesions, the annual mortality rate is 1.6% to 3.2%; prognosis is determined by systolic left ventricular function and the extent of coronary artery disease.(7) Patients can be stratified into low- and high-risk groups by medical history, left ventricular functio n at rest, and results of physical examination and stress testing. Cor onary angiography should be reserved for high-risk patients. Risk fact or modification and appropriate use of antianginal drugs are successfu l in most patients, but those who fail to respond should be considered for angioplasty or coronary bypass surgery; patients with left main c oronary artery disease or three-vessel disease and poor left ventricul ar function should be considered for coronary artery bypass surgery.