A 45-year-old diabetic male patient has returned to clinic following a recent angiogram. He has stable class 2 angina and is currently on aspirin 75 mg od, atorvastatin 40 mg nocte, and bisoprolol 2.5 mg as antianginal treatment. His symptoms have improved since starting the beta-blocker. The angiogram showed severe plaque in the proximal left anterior descending artery and discrete simple lesions in the mid circumflex and right coronary arteries. The echocardiogram has shown moderate LV impairment.
What do you recommend?
A. Titrate the beta-blocker and add a calcium-channel blocker or long-acting nitrate—reassess symptomsThis question tests an understanding of patterns of stable coronary disease where revascularization is associated with prognostic benefit. The evidence generally favours bypass surgery as the mode of revascularization in these cases. The key features are (1) left main stem disease or (2) multivessel disease with (i) proximal LAD involvement or (ii) LV impairment/ large territory of proven ischaemia or (iii) in a diabetic patient. The main PCI prognostic indication for stable coronary disease is proven ischaemia with frequent daily symptoms.