Volume 188 - Issue 2
How should stable coronary artery disease be managed in the modern era?
Authors: Keith V Woollard and Mark A J Newman
Med J Aust 2008; 188 (2): 122-123. || doi: 10.5694/j.1326-5377.2008.tb01542.x
Published online: 21 January 2008
Published online: 21 January 2008
In reply: We agree with Harper and colleagues that for most patients with stable coronary artery disease, prevention of death or other cardiac events is best achieved with medical treatment. Many patients and even some doctors are so impressed by the restoration of coronary blood flow achieved with angioplasty that they incorrectly assume it will provide a prognostic benefit.
However, we do not agree that intervention should be reserved for patients in whom medical treatment has failed. It is unlikely that a trial comparing current medical treatment with coronary artery bypass graft (CABG) surgery for severe left main coronary disease will ever be performed, and current evidence favours CABG at least in this group. In addition, many patients with angina prefer a mechanical intervention to long-term antianginal medications, and why should they be denied that choice?