Individual research recommendation details

Recommendation ID

CG126/2

Question

Management of stable angina in people with evidence of ischaemia on non-invasive functional testing:- Do people with stable angina and evidence of reversible ischaemia on noninvasive functional testing who are on optimal drug treatment benefit from routine coronary angiography with a view to revascularisation?

Any explanatory notes
(if applicable)

Why this is important:- Revascularisation has traditionally been offered to people with stable angina who have evidence of reversible ischaemia on non-invasive functional testing. Recent trials in people with stable angina (COURAGE, BARI-2D, MASS II) have not shown survival benefit from revascularisation compared with drug treatment. In the nuclear substudy of COURAGE (n = 314), PCI was shown to be more effective in treating ischaemia than optimal drug treatment, and in multivariate analyses reduction of ischaemia was associated with greater event-free survival. It is unclear, however, whether people on optimal drug treatment who have evidence of inducible ischaemia on non-invasive functional testing should routinely have coronary angiography and
revascularisation. This question is particularly relevant for people who have responded adequately (for example Canadian Cardiovascular Class 1 or 2) to optimal drug treatment and in whom, based on symptoms alone, revascularisation is not indicated. To answer this question we recommend a randomised trial of interventional management versus continued drug treatment in people with stable angina and myocardial ischaemia on noninvasive functional testing, with all-cause mortality and cardiovascular mortality as the primary endpoints.

Source guidance details

Comes from guidance

Stable angina: management

Number

CG126

Date issued

July 2011

Other details