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Impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease

Lessons from the COURAGE and FAME 2 trials

Einfluss der Myokardischämie auf die myokardiale Revaskularisierung bei stabiler ischämischer Herzkrankheit

Lehren aus den Studien COURAGE und FAME 2

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Abstract

In patients with stable ischemic heart disease (SIHD), myocardial revascularization should be performed to either improve survival or improve symptoms and functional status among patients who are not well controlled with optimal medical therapy (OMT). A general consensus exists on the core elements of OMT, which include both lifestyle intervention and intensive secondary prevention with proven pharmacotherapies. By contrast, however, there is less general agreement as to what constitutes the optimal approach to revascularization in SIHD patients. The COURAGE and FAME 2 randomized trials form the foundation of the current clinical evidence base and raise the important question: “What is the impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease?”

Zusammenfassung

Bei Patienten mit stabiler ischämischer Herzkrankheit (SIHD) sollte eine myokardiale Revaskularisierung erfolgen, um entweder das Überleben oder die Symptome und den Funktionszustand bei Patienten zu verbessern, bei denen die Erkrankung trotz optimaler medikamentöser Therapie (OMT) nicht gut unter Kontrolle ist. Es besteht ein allgemeiner Konsens bei den Kernelementen der OMT, zu denen sowohl eine Änderung der Lebensweise als auch eine intensive Sekundärprävention mit bewährter Pharmakotherapie gehören. Dagegen besteht jedoch eine geringere Übereinstimmung hinsichtlich des optimalen Ansatzes für die Revaskularisierung bei SIHD-Patienten. Die randomisierten Studien COURAGE und FAME 2 bilden die Grundlage der aktuellen klinischen Evidenzbasierung und werfen die wichtige Frage auf: „Wie beeinflusst die Myokardischämie eine myokardiale Revaskularisierung bei stabiler ischämischer Herzkrankheit?“

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Conflict of interest

On behalf of all authors, the corresponding author states the following: Dr. Boden is a Co-principal investigator of the ISCHEMIA trial, Drs. Torosoff and Sidhu are site Sub-PIs for the ISCHEMIA trial, Dr. Sidhu assists Dr. Boden in coordinating North Region sites for the ISCHEMIA trial [ClinicalTrials.gov Identifier:NCT01471522].

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Authors and Affiliations

  1. Albany Medical Center, Albany, NY, USA

    M.T. Torosoff, M.S. Sidhu &  W.E. Boden

  2. Samuel S. Stratton VA Medical Center, 113 Holland Street, 12208, Albany, NY, USA

    M.S. Sidhu &  W.E. Boden

  3. Albany Medical College, Albany, NY, USA

    M.T. Torosoff, M.S. Sidhu &  W.E. Boden

Authors
  1. M.T. Torosoff
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  2. M.S. Sidhu
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  3. W.E. Boden
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Correspondence to W.E. Boden.

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Torosoff, M., Sidhu, M. & Boden, W. Impact of myocardial ischemia on myocardial revascularization in stable ischemic heart disease. Herz 38, 382–386 (2013). https://doi.org/10.1007/s00059-013-3824-0

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  • DOI: https://doi.org/10.1007/s00059-013-3824-0

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