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Optimizing drug therapy is associated with excellent long-term outcomes in patients with stable coronary artery disease (CAD), according to a report published in The American Journal of Cardiology. In such patients, heart surgery can be safely delayed until their disease become less stable.

Optimizing drug therapy is associated with excellent long-term outcomes in patients with stable coronary artery disease (CAD), according to a report published in The American Journal of Cardiology. In such patients, heart surgery can be safely delayed until their disease become less stable. The findings stem from a study of 693 patients with stable CAD who were treated with a strategy that emphasized using maximally tolerated drug therapy in conjunction with behavioral modifications to reduce cardiac risk factors. Most of the patients were men and most had a history of chest pain (angina), but had not had a heart attack. During an average follow-up period of 4.6 years, the annual rates of death from all causes, cardiac death, and non-fatal heart attack were 1.4 percent, 0.8 percent, and 2.2 percent, respectively, Dr. Shmuel Ravid, from Lown Cardiovascular Center in Brookline, Massachusetts, and colleagues note. During follow-up, 24.5 percent of patients underwent coronary revascularization surgery. However, postponing the surgery until they no longer responded to drug therapy or until their heart disease became unstable “was safe and was not associated with higher risk of death or [heart attack],” the researchers note. Predictors of nonfatal heart attack and total mortality included older age, male gender, prior heart attack, diabetes or high blood pressure history, and increased total cholesterol levels, the authors note. In contrast, regular alcohol intake, an increased ejection fraction–a measure of heart function–and use of aspirin, beta-blocker and cholesterol-lowering drugs were all associated with a reduced risk of these adverse outcomes. “Our findings confirm the safety of our conservative strategy as a viable alternative to a rushed invasive approach in many patients with documented stable CAD,” the investigators conclude. (SOURCE: American Journal of Cardiology, Reuters Health, March 2004)