Optimal Medical Therapy as First-Line Therapy for Chronic Coronary Syndromes: Lessons from COURAGE, BARI 2D, FAME 2, and ISCHEMIA

Cardiovasc Drugs Ther. 2022 Oct;36(5):1039-1045. doi: 10.1007/s10557-021-07289-6. Epub 2021 Nov 12.

Abstract

The chronic coronary syndromes (CCS) include patients with a classic history of angina pectoris in the presence of either risk factors for or known atherosclerotic coronary artery disease. Randomized, controlled trials conducted in the optimal medical therapy (OMT) era have convincingly demonstrated that adherence to the outdated paradigm focused on treatment of obstructive coronary disease with initial revascularization fails to reduce death or myocardial infarction and inconsistently reduces angina symptoms. Rather, OMT reduces events and improves symptoms and should be considered first-line treatment for patients with CCS.

Keywords: Angina; Coronary artery disease; Ischemia; Medical therapy; Revascularization.

Publication types

  • Review

MeSH terms

  • Angina Pectoris / diagnosis
  • Angina Pectoris / drug therapy
  • Coronary Artery Disease* / diagnosis
  • Coronary Artery Disease* / drug therapy
  • Courage*
  • Humans
  • Myocardial Infarction*
  • Syndrome
  • Treatment Outcome