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World J Clin Cases. Feb 16, 2015; 3(2): 163-170
Published online Feb 16, 2015. doi: 10.12998/wjcc.v3.i2.163
Conservative strategy for treatment of stable coronary artery disease
Paulo Cury Rezende, Thiago Luis Scudeler, Leandro Menezes Alves da Costa, Whady Hueb
Paulo Cury Rezende, Thiago Luis Scudeler, Leandro Menezes Alves da Costa, Whady Hueb, Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, São Paulo 05403-000, Brazil
Author contributions: All the authors contributed equally to this review article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Whady Hueb, MD, PhD, Department of Atherosclerosis, Heart Institute (InCor) of the University of São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo 05403-000, Brazil. whady.hueb@incor.usp.br
Telephone: +55-11-26615032 Fax: +55-11-26615188
Received: August 6, 2014
Peer-review started: August 8, 2014
First decision: October 14, 2014
Revised: October 25, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: February 16, 2015
Processing time: 183 Days and 16.3 Hours
Abstract

Patients with coronary artery disease vary widely in terms of prognosis, which is mainly dependent on ventricular function. In relation to the major outcomes of death and myocardial infarction, it is not clear in the literature if an invasive strategy of myocardial revascularization is superior to a conservative strategy of optimized medical therapy. Moreover, with the exception of patients with left main coronary disease, this similarity in prognosis also occurs in different subgroups of patients.

Keywords: Coronary artery disease; Angina pectoris; Myocardial revascularization; Coronary angioplasty; Myocardial infarction; Prognosis; Disease-free survival

Core tip: Despite the evolution of myocardial revacul-arization techniques, the mainstay of treatment of stable coronary artery disease is optimal medical therapy. With the better understanding of the mechanisms underlying atherosclerosis, medical therapy develops and shows similar results in terms of survival and freedom from myocardial infarction compared to coronary interventions. Moreover, clinical trials have also demonstrated similar results between conservative and invasive strategies in various subgroups of patients, previously found to benefit from coronary interventions. In this review article, the authors discuss the results from main trials on specific groups of coronary artery disease patients which compared conservative and invasive strategies.