Artículos de revistas
Chronic Coronary Ischemia [isquemia Coronaria Crônica]
Revista Brasileira De Medicina. , v. 58, n. SPEC. ISS., p. 161 - 171, 2001.
De Ueti A.A.
Investigation, risk stratification and treatment of the patient with chronic coronary ischemia has the goals of relieving symptoms and of improving prognosis. Patients at high risk of death and non-fatal myocardial infarction should undergo angiography, with a view to intervention by percutaneous transluminal coronary angiosplasty (PTCA) or coronary artery bypass grafting (CABG). It is difficult to ignore the surgical benefit for left main stem, three-vessel disease, with or without impaired left ventricular function, and two-vessel disease involving the proximal left anterior descending. Medical therapy is appropriate as first-line therapy in those patients not identified as being at high risk by non-invasive methods or coronary angiography. If the medical therapy fails, both angiosplasty and bypass grafting can give relief of symptoms for the same low morality rates. When compared with surgery, PTCA does not reduce or increase morality; revascularization is less incomplete, re-intervention and additional anti-anginal therapy more frequently necessary. There is no evidence that coronary angioplasty in the context of stable angina improves survival, in patients with modest single-vessel, or perhaps even double-vessel, disease in the presence of no, or minimal, symptoms. On the other hand, angioplasty has been shown to give better symptomatic relief than medical treatment. Finally, there is not exclusive treatment and medical therapy may frequently provide additional benefit when prescribed for patients after PTCA or CABG.58SPEC. 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