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Comment & Response |

Treatment of Patients With Stable Ischemic Heart Disease

Fernando Civeira, MD, PhD1; Rocío Mateo-Gallego, PhD1
[+] Author Affiliations
1Hospital Universitario Miguel Servet, IIA Aragon, Zaragoza, Spain
JAMA. 2016;315(17):1904-1905. doi:10.1001/jama.2016.0680.
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To the Editor In a recent issue of JAMA, 2 articles differed on the correct treatment of patients with stable ischemic heart disease. In a Viewpoint on evidence-based management of stable ischemic heart disease, Dr Bangalore and colleagues reviewed evidence showing that coronary revascularization was not associated with a reduction in death, myocardial infarction, unplanned revascularization, or angina compared with medical therapy alone and recommended that revascularization should not be performed as first-line treatment in most stable patients.1 However, Drs Polonsky and Blankstein, in a JAMA Diagnostic Test Interpretation, presented a case of a 53-year-old man with mild angina after running more than 2 miles, with no other symptoms. He underwent an exercise treadmill test (ETT), which showed excellent functional capacity, absence of chest pain, and a Duke Treadmill Score of 5.5 (low risk [ie, <1% mortality/year]). Despite stable disease, mild symptoms, excellent exercise capacity, and low risk, the patient underwent a coronary angiogram and subsequent coronary artery bypass graft (CABG) surgery.2 Hence, his treatment appears to contradict that recommended by Bangalore et al. Inappropriate coronary revascularization is a problem worldwide, and although recent years have seen improvement, it still represents a high percentage of all revascularization procedures.3 Contradictory messages may contribute to this important problem.


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May 3, 2016
Tamar S. Polonsky, MD, MSCI; Ron Blankstein, MD
1University of Chicago, Chicago, Illinois
2Brigham and Women’s Hospital, Boston, Massachusetts
JAMA. 2016;315(17):1906-1907. doi:10.1001/jama.2016.0695.
May 3, 2016
Sripal Bangalore, MD, MHA; David J. Maron, MD; Judith S. Hochman, MD
1New York University School of Medicine, New York
2Stanford University School of Medicine, Stanford, California
JAMA. 2016;315(17):1905-1906. doi:10.1001/jama.2016.0698.
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