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CHAPTER SUMMARY AND CENTRAL ILLUSTRATION
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Content Update
ORBITA-COSMIC: Coronary Sinus Reducer for the Treatment of Refractory Angina
The ORBITA-COSMIC trial was a randomized, double-blind, placebo-controlled trial of a coronary sinus reducer (CSR), a stainless-steel mesh that is percutaneously implanted into the coronary sinus to reduce angina. Read More
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Content Update
PREVENT Trial: Impact of Percutaneous Coronary Intervention in Patients with Vulnerable Non-Obstructive Coronary Plaques
The PREVENT trial was a multicenter, open-label, randomized controlled trial involving 1,606 patients undergoing invasive coronary angiography for stable ischemic heart disease or acute coronary syndrome. Read More
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ORBITA-2
ORBITA-2 was a double-blind, randomized, placebo-controlled trial comparing percutaneous coronary intervention (PCI) to sham procedure in patients with stable angina not taking antianginal medications. Read More
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Content Update
OCT versus IVUS versus angiography guidance: a real-time updated network meta-analysis
This network meta-analysis comprised 20 randomized trials of percutaneous coronary intervention (PCI) guided by intravascular imaging (IVI) compared with angiography guidance alone. Read More
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Survival After Invasive or Conservative Management of Stable Coronary Disease: The ISCHEMIA EXTEND Interim Report (ISCHEMIA-EXTEND)
ISCHEMIA was an international, multicenter, randomized controlled trial comparing an initial invasive versus an initial conservative management strategy for patients with chronic coronary disease and moderate or severe ischemia, not including patients with unprotected left main disease, heart failure with LVEF ≤35% or NYHA class III/IV symptoms, kidney disease, recent acute coronary syndrome, or refractory angina. Read More
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RESPECT EPA Trial
The RESPECT EPA trial is an open-label trial of 3,844 Japanese patients (mean age 68 years) with CAD already on statin therapy. Read More
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PANTHER: What is the optimal antiplatelet monotherapy for established coronary artery disease?
To date, the antiplatelet agent of choice for secondary prevention in coronary artery disease has been aspirin. Read More
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Chapter Summary
This chapter reviews the epidemiology, diagnosis, and management of chronic coronary syndromes (see Fuster & Hurst’s Central Illustration). Assessment of pretest probability of coronary artery disease (CAD) aids in appropriate risk stratification of patients with suspected chronic coronary syndromes. The Duke, updated Diamond–Forrester, and CORSCORE risk models are the most accurate in predicting CAD. The ischemic cascade is based on progressive mismatch between coronary blood flow and myocardial oxygen demand and, since perfusion defects occur earlier than do wall motion abnormalities, tests that rely on detection of perfusion defects (such as SPECT) are more sensitive than those that detect wall motion abnormalities (such as stress echocardiography), which are more specific for the detection of obstructive CAD. Detection of CAD by coronary computed tomography angiography is associated with a reduced incidence of myocardial infarction. Goal-directed medical therapy consists of intensive and comprehensive secondary prevention and includes lifestyle and pharmacological approaches. Patients with refractory symptoms despite goal-directed medical therapy, and/or elevated clinical or angiographic risk profiles and suitable coronary anatomy, may benefit from revascularization. Coronary ...