Introduction: In patients with stable coronary artery disease, there are controversial studies that compare the optimal medical therapy with revascularization therapy in reducing the risk of cardiovascular events.
Material and method: The study included 221 patients with stable coronary artery disease who underwent coronarography and had objective evidence of significant coronary disease. Of these, 73 underwent percutaneous coronary intervention, 71 underwent coronary artery bypass grafting, both subgroups with optimal medical therapy, and 77 received optimal medical therapy alone. Primary outcomes were cardiac death and non fatal myocardial infarction, during a follow-up period of 4.5 years. Secondary outcomes were persistent disabling angina (quality of life) and the need for repeat revascularization.
Results: There were 15 primary events in the medical-therapy group, 5 events in the surgical group and 5 events in the percutaneous coronary intervention group. In subgroups analysis, among patients with non-high risk criteria (one or two-vessel disease, without significant ventricular dysfunction), the primary outcome was 2.5% in the medical group and 1.78% in the PCI group, while the persistent disabling angina occurred in 22.5% in the medical group versus 12.50% in the interventional group versus 18.75% in the coronary artery bypass grafting group (p = 0.42). Among high-risk criteria patients there was a tendency for increased repeat target vessel revascularization in the interventional group vs surgical group (17.64% vs 5.45%). The primary outcome was similar in both groups (11.76% vs 9.09%).
Conclusion: For patients with stable angina that is not significantly interfering with the quality of life and without high-risk characteristics, medical therapy rather than immediate revascularization seems to be the right option. Patients with high-risk criteria benefit from a more complete revascularization by coronary artery bypass grafting, but most often the patient will prefer the interventional aproach.

Introduction: In the past decades there were many studies that compared different therapeutic approaches in stable coronary artery disease. Since then major pharmacological and technical advances occurred on the management of stable angina. It is only in recent years that these advances were widely used. Given the above, the objective of our study was to evaluate the clinical outcome of high-risk patients with stable angina pectoris who received modern treatment — medical therapy, percutaneous revascularization or surgical revascularization.
Material and method: Study included 115 patients with stable coronary disease and high-risk criteria for major adverse cardiac events (MACEs) – left main or proximal left anterior descending artery stenosis > 50%, 2 or 3-vessel disease with impaired left ventricular function. Of these, 39 underwent percutaneous coronary intervention (PCI), 44 underwent coronary artery bypass grafting (CABG), both subgroups with optimal medical treatment (MT), and 32 received optimal MT alone. Primary outcomes were cardiac death and non-fatal myocardial infarction, and secondary outcomes were persistent disabling angina (quality of life) and the need for repeated revascularization. The follow-up period was 4 years.
Results: The primary outcome was 25.00% in the MT group, 5.12% in the PCI group and 4.54% in the CABG group (p=0.006). There was no statistically significant difference in primary events between PCI and CABG group (p=1.00), but the primary events were significantly higher in the MT group vs CABG group (p=0.014) and versus PCI group (p=0.03). Angina persists in 50.00% of patients in MT group versus 20.51% in the PCI group (p=0.01) and 9.09% in the CABG group (p=0.0001). There is no difference between the last two groups (p=0.21). In addition we found a tendency for increased repeated target vessel revascularization in the interventional group (15.38%) versus surgical group (2.27%) (p= 0.04). Drug eluting stents were used in 56.41% of cases.
Conclusions: All patients with stable coronary disease should receive modern medical treatment and aggressive risk factor reduction. Early coronarography represents an important step in risk stratification of these patients. Patients with extensive coronary disease, especially associated with impaired left ventricular function, or left main disease, benefit from CABG. Patients with less severe coronary disease may experience relief of symptoms after PCI, but repeated revascularization is often required.