Keynote Address Balram Bhargava / Current Management of Chronic Stable Angina

Balram Bhargava
Professor, Senior Resident, Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India 

Chronic stable angina (CSA) is defined as chest discomfort which occurs predictably and reproducibly at a certain level of exertion and is relieved with either rest or nitroglycerin. The management of CSA has three major aspects which are preventive therapy, pharmacological therapy for angina and revascularization.
Preventive therapy includes low dose aspirin, risk factor reduction such as treatment of hypertension, diabetes and cessation of smoking. All patient should be on at least moderate intensity statins. ACE inhibitors have a major role in patients who are having hypertension, diabetes and chronic kidney disease.
Beta blockers, nitrates and calcium channel blockers are three first line class of anti-anginal drugs. Ranolazine and Nikorandil are newer drugs which may be used as combination therapy with the above.
All patients who continue to be having angina despite maximal tolerable doses of anti-anginals should be considered for coronary angiography followed by revascularization as deemed appropriate either by percutaneous coronary intervention or coronary artery bypass surgery. Other indications of angiography are intermediate or high risk criteria on non invasive stress testing irrespective of severity of angina.The choice of initial stress test such as treadmill test, nuclear imaging, or pharmacologic stress testing with imaging depends on patients baseline ECG and ability to perform exercise.
The management of CSA has improved tremendously over the past few years and is more evidence based now. Consequently, the outcome seems to have been improving.