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Review of Medical Treatment of Stable Ischemic Heart Disease

International Journal of Clinical Medicine 2014年第5期5卷 249-259页

作者： Abdulelah F. al Mobeirek Hanan albackr mostafa al shamiri Turki B. albacker King Fahad Cardiac Center College of Medicine King Saud University Riyadh KSA

Medical treatment is the initial treatment strategy and is the cornerstone of management in patients with stable ischemic heart disease (IHD). Many patients are not suitable for percutaneous or surgical revascularization because of unfavourable anatomy, or the presence of co-morbidities. In addition, many patients have recurrence of angina following revascularization due to restenosis or incomplete revascularization. Furthermore, randomized clinical trials comparing optimal medical treatment to revascularization have not clearly shown that myocardial revascularization is superior to optimal medical treatment. Traditional drugs for angina treatment include b-blockers, calcium channel blockers and nitrates. Newer drugs are available with different mechanisms of action and with equal efficacy that do not cause significant hemodynamic deterioration. The availability of these newer drugs expands the therapeutic potential of medical treatment to even a wider population with stable IHD. Revascularization in patients with stable ischemic heart disease has never been shown to reduce hard endpoints (death or myocardial infarction) in randomized clinical trials.

关键词： Medical Treatment Stable Ischemic Heart Disease Novel Anti-Ischemic Therapy Anti-Anginal Agents Coronary Artery Disease

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Review: Outcomes of Revascularization Strategies for Coronary Artery Disease

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International Journal of Clinical Medicine 2014年第5期5卷 260-274页

作者： Turki B. albacker Hanan albackr mostafa al shamiri Abdulelah F. al Mobeirek King Fahad Cardiac Center College of Medicine King Saud University Riyadh KSA

The optimal revascularization strategy for patients with coronary artery disease is influenced by the continuous improvement in medical therapy and the improved designs of the new generation of coronary stents allowing them to be increasingly applied in patients with complex coronary anatomy, including those with left main stem disease. On the other hand, surgical results are also improved as a result of the increased experience over years and the improvement of myocardial protection techniques. This will make the comparison of percutaneous coronary interventions and coronary artery bypass surgery a moving target. In this paper, we reviewed the recent randomized controlled trials and important registries emphasizing the benefits and the results of each therapy in different patient subsets. A heart team of both cardiologists and cardiac surgeons is of paramount importance in choosing the optimal revascularization strategy.

关键词： Outcomes Revascularization Coronary Artery Bypass Grafting Percutaneous Coronary Intervention Survival Major Adverse Cardiovascular Cerebrovascular Events

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Review: Do We Still Need a Viability Study before Considering Revascularization in Patient with Stable Coronary Artery Disease and Significant Left Ventricular Systolic Dysfunction?

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International Journal of Clinical Medicine 2014年第5期5卷 242-248页

作者： Hanan albackr Abdulelah F. al Mobeirek mostafa al shamiri Turki B. albacker King Fahad Cardiac Center College of Medicine King Saud University Riyadh KSA

Patients with ischemic cardiomyopathy constitute a heterogeneous group of patients with an extremely complex condition in which many factors play an important prognostic role. So it is difficult and probably unrealistic to expect that a single feature like presence of viable myocardium would provide an unequivocal answer to a critical question of revasculrization or not for all patients. Opposite to the hopes of investigators and physicians involved in the care of these patients, the findings of prospective studies with the use of different viability testing methods did not help in the decision-making process regarding CABG in ischemic cardiomyopathy. Instead, they left us with the same dilemma. The implication of most of these trials is that in patients with CAD and significant LV dysfunction, assessment of myocardial viability does not identify patients who will have the greatest survival benefit from adding CABG to aggressive medical therapy. In the clinical practice, these observations remind physicians to consider the multiplicity of factors involved in the decision-making process for patients with such a complex disease.

关键词： Viability Revascularization Coronary Artery Bypass Grafting Left Ventricular Dysfunction

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Percutaneous Coronary Interventional Treatment for Coronary Artery Disease and the Role of Antiplaplatelets Therapy: A Review of the Literature

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International Journal of Clinical Medicine 2014年第5期5卷 275-283页

作者： mostafa al shamiri Abdulelah F. al Mobeirek Hanan albackr Turki B. albacker King Fahad Cardiac Center College of Medicine King Saud University Riyadh KSA

Uses of balloon catheters or BMS for the treatment of coronary artery lesions shows good short-term results but long-term follow up revealed restenosis in up to 20%-30% of patients. Thus new improvements to balloons and stents are always necessary to achieve the best results from percutaneous coronary intervention (PCI). Drug-eluting stents (DES) improved the principles of bare metal stents (BMS) by local drug release to inhibit neointimal growth. DES reduced the incidence of in-stent restenosis. These benefits and lower costs compared to surgical treatment make the DES an attractive alternative for the treatment of coronary artery disease. Different components of DES which include the polymers, drugs and the stents underwent progressive evolution, and these led to development of new generations of DES with variable types of drugs and polymers to fully absorbable stents. The concern of stent thrombosis still an issue and dual antiplatlets therapy (DAPT) is mandatory for variable time ranging from one month to one year. This article discusses the main available clinical trials in the developments of BMS, DES and the comparison between both with a prospective look at future technologies in the field, in addition to reviewing the current guideline in the uses of DAPT after PCI.

关键词： Percutaneous Coronary Intervention Coronary Artery Disease Antiplatelets Coronary Stents Drug Eluting Stents Bare Metal Stents

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