Still Looking for Ischemic Threshold for Coronary Revascularization

Background: Invasive coronary revascularization has been shown to be beneficial in the setting of acute coronary syndrome. However, in stable ischemic heart disease, it appears that coronary revascularization in addition to optimal medical therapy does not reduce death or major cardiovascular events. Objective: To evaluate the evidence for ischemia testing in stable ischemic heart disease. Design: Literature review. Results: Recent clinical trials looking at invasive revascularization plus or minus guideline-directed medical therapy in stable ischemic heart disease have not shown a clear benefit of revascularization. Observational studies have suggested that there is an ischemic threshold above which revascularization is beneficial. One drawback to the recent clinical trials comparing revascularization plus or minus optimal medical therapy is that the eligibility criteria established for patient participation has mandated minimal standards for ischemia. Conclusions of Specific Trials more...