Contemporary management of angina: part I. Risk assessment

Ischemic heart disease is one of the most common disorders managed by famil y physicians. Stratifying patients according to risk is important early in the course of the disease to identify patients who require invasive (percut aneous or surgical) treatment. Physical examination, clinical history, noni nvasive tests and angiography are all helpful in determining who will benef it most from medical therapy, percutaneous revascularization or coronary ar tery bypass surgery. Surgery improves morbidity and mortality in a well-def ined group of patients with left Ventricular dysfunction and left main coro nary artery disease or triple-vessel disease. Patients with proximal left, anterior descending artery disease and moderate or severe ischemia benefit from surgery as well. In all other patients, definitive treatment includes aspirin, beta-adrenergic blockers and lipid-lowering agents. Percutaneous r evascularization should be considered primarily a palliative measure, becau se it has never been shown to improve mortality more than medical therapy.