Evolving Roles of Optimal Medical Therapy and PCI in Chronic Coronary Syndrome Patients with Stable Angina: Introduction

This Introduction sets the stage for 5 subsequent papers that will follow, and which describe several key features of the ISCHEMIA Trial in depth, including clinical outcomes, beginning with a detailed discussion by Dr. David L. Brown from Washington University, St. Louis, MO on the "importance of OMT in the management of CCS patients" and how the results of ISCHEMIA reinforce the findings of earlier strategy trials in CCS patients. Drs. Rasha Al-Lamee and Darrel Francis from Royal College of London, UK, will discuss the important topic of "how to assess quality of life improvement with revascularization in CCS patients with chronic angina and lessons learned the ORBITA trial, including the importance of unblinded vs. blinded trials". Drs. Kreton Mavromatis from Emory University, Atlanta, GA and Eric Bates from the University of Michigan, Ann Arbor, MI, will next discuss whether (and how) the "role of revascularization and, in particular, PCI in CCS patients has changed following the publication of the ISCHEMIA Trial", followed by a paper highlighting the important role of assessing myocardial ischemia and no obstructive coronary arteries (INOCA) in patients with CCS and why this represents both an under-diagnosed and under-treated cause of chronic angina, especially in women with suspected CAD. Finally, the concluding paper by Drs. Boden, Kaski, and Bernard Gersh from the Mayo Clinic, Rochester, MN, will summarize "the future of managing chronic stable angina and how best to synthesize recent clinical trials evidence with evolving CCS management guidelines".