Usually, stable coronary artery disease is managed with the use of medication. This medication often centres on preventing myocardial infarction and death. There are also anti-anginal medications that have proven beneficial for reducing the symptoms of coronary artery disease. However, before these medications were all available, revascularization with coronary artery bypass grafting or percutaneous coronary intervention were used to reduce symptoms. Recently, clinical trials have been assessing the benefit of this procedure. The strict inclusion criteria of trials mean the full breadth of coronary artery disease is not always captured, meaning new trials have to be designed to build upon the previous trials. For example, the COURAGE trial did not randomise patients before coronary angiography, so the ISCHEMIA trial was designed to do this. Overall, the trials examined the cost of revascularisation in terms of the risks of bleeding, myocardial infarction and even death. The day after revascularization is completed, the risk of adverse events is always at a much higher rate for patients with revascularization versus those without, meaning this risk and whether it is worth it needs to be understood.

This review by Al-Lamee RK et al. aimed to understand whether revascularisation is useful and necessary for patients with stable coronary artery disease.

Key learnings

Recently, there have been many trials and studies to assess the use of revascularisation for coronary artery disease, assessing the risks of death, myocardial infarction and angina. Overall, there have been limited reductions in the risk of these events when undergoing revascularisation. It seems the conclusion to be drawn is that coronary artery disease requires medical therapy to provide impactful treatment.