Focused Update Published on Treatment of Patients With Stable Ischemic Heart Disease

August 6, 2014—Stephan D. Fihn, MD, et al published the 2014 multisociety focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease (SIHD). This is a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. The focused update of the guideline is available online ahead of print in Journal of the American College of Cardiology.

As noted in the update, these guidelines are intended to apply to adult patients with stable known or suspected ischemic heart disease, including those with new-onset chest pain (ie, low-risk unstable angina) or stable pain syndromes. Patients who have “ischemic equivalents,” such as dyspnea or arm pain with exertion, are included in the latter group. Many patients with ischemic heart disease may become asymptomatic with appropriate therapy.

Accordingly, the follow-up sections of this guideline pertain to patients who were previously symptomatic, including those who have undergone percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). In this document, “coronary angiography” is understood to refer to invasive coronary angiography.

Late-breaking clinical trials presented at the 2012 scientific meetings of the American College of Cardiology, American Heart Association, and European Society of Cardiology, as well as other selected data reported through October 2013, were reviewed by the 2012 SIHD guideline-writing committee along with the Task Force and other experts to identify trials and other key data that might affect guideline recommendations. On the basis of the criteria and considerations noted in the document’s preamble, recently published trial data and other clinical information were considered important enough to prompt a focused update of the 2012 SIHD guideline.

The guideline addresses the use of invasive testing for diagnosing coronary artery disease in patients with suspected SIHD. Also addressed are guideline-directed medical therapy, additional medical therapy to prevent myocardial infarction and death, and additional therapy to reduce risk of myocardial infarction and death.

Section 5 of the guideline covers coronary artery disease revascularization to improve survival and compares CABG versus PCI and CABG versus drug-eluting stents. The guidelines also provide an overview of studies comparing PCI versus CABG for left main coronary artery disease. As a special consideration, the guideline discusses the treatment of patients with diabetes mellitus.