Clinical Management of Chronic Stable Angina

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Clinical Management of Chronic Stable Angina
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Anti-ischemic strategies in stable CAD
Initial therapy
Medical therapy PCI CABG
Recurrent ischemia
? Antianginal drug therapy(uptitrate/add new
agents)
Repeat revascularization (if possible)
TMR EECP SCS
TMR transmyocardial revascularization EECP
enhanced external counterpulsation SCS spinal
cord stimulation
Gibbons RJ et al. ACC/AHA 2002 guidelines.
http//www.acc.org/clinical/guidelines/stable/stab
le.pdf.
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Older antianginal drugs Pathophysiologic effects
O2 Demand
O2 Supply
Coronary blood flow
Arterial pressure
Venous return
Myocardial contractility
Heart rate
Drug class
ß-blockers DHP CCBs Non-DHP CCBs Long-acting
nitrates

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Boden WE et al. Clin Cardiol. 20012473-9.
Gibbons RJ et al. ACC/AHA 2002 guidelines.
www.acc.org/clinical/guidelines/stable/stable.pdf
Kerins DM et al. In Goodman and Gilmans The
Pharmacological Basis of Therapeutics. 10th ed.
CCB calcium channel blocker DHP
dihydropyridine Except amlodipine
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Older antianginal drugs Clinical conditions that
may limit use
Drug class Drug class Drug class
ß-blockers Nitrates Calcium channel blockers
Asthma Severe bradycardia AV block Severe depression Raynauds syndrome Sick sinus syndrome Severe aortic stenosis Hypertrophic obstructive cardiomyopathy Erectile dysfunction AV block Bradycardia Heart failure Left ventricular dysfunction Sinus node dysfunction
Treated with PDE5 inhibitors Nondihydropyridine
CCBs
Gibbons RJ et al. ACC/AHA 2002 guidelines.
www.acc.org/clinical/guidelines/stable/stable.pdf
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Unmet needs in antianginal therapy

• Despite medical therapy and/or revascularization,
  some patients continue to experience angina
• Current treatment options for recurrent angina
  are limited
• Consensus on role of newer treatments is pending
• How best to manage symptomatic patients?