Authors' objectives:

This report examines the evidence for the effectiveness and cost-effectiveness of medical therapy, CABG and PTCA in treating patients with stable angina.

Authors' recommendations: People with stable angina are at increased risk of heart attack and death. Targeting this group with effective treatments is an important component of a coronary heart disease strategy. Initial treatment choice should take into account disease severity. In less severe disease, medical treatment is as effective as angioplasty (PTCA) in relieving symptoms, and has better survival rates than PTCA or coronary artery bypass grafting (CABG). In more severe disease, invasive procedures are more appropriate. CABG is slightly better at relieving angina than PTCA and is more appropriate for patients with more severe or extensive disease. Many patients receiving PTCA require retreatment. There is a need for research-based guidance on clinical indications for further investigation and invasive procedures in order to increase the appropriateness and cost-effectiveness of treatment. Many patients will benefit from long-term low-dose aspirin and lipid-lowering therapies either as primary treatment or as an adjunct to invasive procedures. Despite little evidence that coronary stents are more cost-effective than standard angioplasty they are increasingly being used. The adoption of this or other new technologies should be managed in line with the results of reliable trials. There is evidence of unequal access to testing and revascularisation, by gender, ethnic group and social class. This suggests a need to monitor access in order to promote equity.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/ehcb.htm

Year Published: 1997

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination