Unmet medical needs and therapeutic opportunities in stable angina
Department of Cardiology, Hôpital Bichat-Claude Bernard
Assistance Publique, Hopitaux de Paris, 46 rue Henri Huchard, 75877 Paris Cedex 18, France
* Corresponding author. Tel: +33 140258668; fax: +33 140258865. E-mail address: gabriel.steg{at}bch.ap-hop-paris.fr
Stable angina is a frequent problem and it impacts on outcomes and quality of life. The treatment of stable angina includes a wide array of tools, including medical therapy and percutaneous and surgical revascularization. In the past decade, the use of myocardial revascularization techniques has tremendously expanded; new anti-ischaemic therapies have emerged and secondary prevention strategies are ever more effective. However, despite these advances, there remain important unmet medical needs in the treatment of angina pectoris. Many patients are not amenable to revascularization or experience angina despite having had revascularization. In addition, a substantial proportion of patients who are on medical therapy (even including patients with prior revascularization) still experience anginal symptoms. Current medical therapy has shortcomings, mainly related to insufficient efficacy, lack of haemodynamic tolerance and side effects. There is currently little proof of a direct impact of anti-ischaemic therapy on clinical outcomes in the context of stable angina. More studies are needed to explore the impact of anti-anginal therapies on outcomes in the revascularization era. In addition, there is evidence of underuse of effective, evidence-based therapies in patients with coronary artery disease. Efforts are needed to improve physician adherence to prescription guidelines and long-term patient compliance with polytherapy.
Key Words: Angina • Evidence-based medicine • Revascularization