The patient with symptomatic coronary artery disease and a pathological coronary angiogram. "Evidence-based" or "best-evidence medicine" in the interventional cardiology

Ischemic heart disease is the most frequent cause of death in industrialize d countries. This is a result of persistent risk factors and aging of the p opulation. Medical progress with application of conservative, surgical or i nterventional strategies indeed reduced the morbidity and mortality of arte riosclerotic diseases, but markedly increased the medical care costs. The r esult is a discussion about the optimal use of the different therapeutic me asures under consideration of the evidence based medicine. This article reviews several recently published clinical trials and discuss es, which patient with symptomatic coronary artery disease should undergo a conservative strategy, percutaneous or surgical revascularization.