Managing chronic stable angina needs understanding of the benefits of various treatment options

Chronic stable angina is a common condition with significant morbidity and mortality. The diagnosis and initial plan of management is mainly based on an exercise ECG. Anti-ischaemic agents relieve symptoms but their effect on mortality in patients with chronic stable angina has not been tested vigorously in controlled studies. Most data are from studies in patients with unstable angina or myocardial infarction. Based on these data and the fact that they reduce silent ischaemia, a surrogate marker for mortality benefit, β-blockers are believed to reduce long term mortality in patients with chronic angina. In contrast, the mortality benefit of lipid-lowering therapy and antiplatelet agents is well proven. Revascularisation is usually indicated in patients not responding to antianginal drugs. Coronary angioplasty is effective in relieving symptoms in such patients but it does not have any proven mortality benefit. Coronary artery bypass surgery offers a distinctive advantage in patients with left main-stem disease or with triple vessel disease and left ventricular (LV) dysfunction.