Chronic stable angina treatment

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; John Fani Srour, M.D.; Jinhui Wu, M.D.; Lakshmi Gopalakrishnan. M.B.B.S.


Treatment of chronic stable angina aims at minimizing symptoms, reducing recurrent ischemia, improving the quality of life and improving prognosis by preventing MI and death. Treatment options include lifestyle modification, pharmacotherapy and revascularization that help in slowing the disease progression, preserving the endothelial function and preventing thrombosis.

Patients with single-vessel CAD may be started on initial pharmacologic therapy and if non-responsive or symptomatic despite on therapy, PCI may be a preferred alternative.

Patients with double-vessel CAD and with normal LV function may be started on initial medical management and in non-responders, PCI may be considered. However, the decision of PCI versus CABG depends on the coronary anatomy, LV function and the need for complete revascularization.

Patients with triple-vessel CAD or left main disease or reduced left ventricular function, CABG is the mainstay of management. However, in cases of mild symptoms or preserved LVEF in patients with triple-vessel disease, initial pharmacologic therapy or PCI may be tried.


Precipitating Factors

  • While chronic stable angina may be due to underlying atherosclerosis, other factors may either precipitate or exacerbate angina.
  • Identification and management of these conditions may reduce the frequency and intensity of anginal episodes. These conditions include:

Risk Factor Modification

  • Initiation of intensive modification of risk factors is an urgent and essential part of the main therapy in chronic stable angina.
  • Initiate risk factor modification, promote regular physical exercise (all patients should be encouraged to obtain 30 to 60 minutes/day of regular aerobic activity), low fat diet, and lifestyle modification.
  • You can read in greater detail about each of the risk factor modification topics below:
Smoking Cessation | Weight Management | Physical Activity | Lipid Management | BP Control | Diabetes Control | ACC/AHA Guidelines for Cardiovascular Risk Factor Reduction

The Treatment Essentials

Alphabet of chronic stable angina management: Elements listed below are the most important components of stable angina management.


  • The role of pharmacotherapy in the management of chronic stable angina is to reduce the severity and frequency of symptoms and to provide a bettered overall prognosis.
  • You can read in greater detail about each of the pharmacotherapies for chronic stable angina below by clicking on the link for that topic:


  • Revascularization is only used for select patients specially those who have uncontrolled symptoms with optimal medical therapy.
  • In general, PCI is reserved for single or some cases of two vessel disease, and
  • CABG is reserved for patients with two or three vessel disease or left main disease.
  • With the availability of drug-eluting stents, PCI is increasingly being performed for many lesions including more complex ones.
  • You can read in greater detail about specific revascularization approaches for the treatment of chronic stable angina by clicking on the link below for that topic.
PCI | CABG | PCI vs CABG | ACC/AHA Guidelines for Revascularization

Alternative Therapies for Refractory Angina

You can read in greater detail about each of the alternative therapies for refractory angina below by clicking on the link for that topic:


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