Strategies for chronic coronary syndrome has two strategies:
Conservative strategy uses medical therapy including anti-anginal drugs as well as disease modifying agents such as hypolipidemic, anti-thrombotic, and renin-angiotensin blocking therapies.
Invasive strategy adds coronary angiography, followed by percutaneous coronary intervention or coronary artery bypass grafting.
In a trial of 5179 patients (ISCHEMIA) with stable ischemic heart disease and moderate or severe myocardial ischemia underwent randomization of conservative and invasive strategies.
In the above trial 96% of the patients in the invasive strategy group underwent coronary angiography, whereas only 26% of the conservative treated group did so.
They were no significant differences between the two strategies in the rate of death from cardiovascular causes, myocardial infarction, or hospitalizations or unstable angina, heart failure, or resuscitated cardiac arrest, or in the rate of death from any cause for myocardial infarction.
The invasive strategy did not appear to be associated with clinically meaningful differences in outcomes during 40 years of follow up.
Patients with stable ischemic heart disease, who do not have an unacceptable level of angina can be treated with a an initial conservative strategy.
Patients with stable coronary artery disease treated conservatively and medically as opposed to invasive stent placement or a bypass surgery showed similar risk for cardiovascular death, myocardial infarction heart failure, and cardiac arrest or hospitalization (ISCHEMIA trial).
An invasive strategy is more effective in relieving symptoms of angina, and a reasonable approach at any point in time for symptom relief.
Patients with advanced chronic kidney disease and stable ischemic heart disease have a more than three times risk of clinical events than individuals without chronic kidney disease.