Ischemic heart disease: a patient-specific therapeutic approach with emphasis on quality of life considerations.

Advantages and disadvantages of the various therapies for stable angina are considered with particular attention to quality of life. Advantages of coronary artery bypass surgery (CABS), apart from the question of survival, include less angina, less activity limitation, and less need for drugs than with medical treatment. However, data from the Coronary Artery Surgery Study (CASS) and others show that there is no difference between medical and surgical therapy in return to work and in need for subsequent hospitalization. In CABS patients, there is also predictable return of angina, substantial late vein graft occlusion, and possibly increased progression of native coronary artery disease in grafted vessels. Percutaneous transluminal coronary angioplasty (PTCA) has advantages similar to those of CABS, with very low initial mortality and major complication rates, minimal discomfort, very short disability period, and moderate cost. Its major disadvantages are a high short-term reocclusion rate and uncertain long-term outcome. Beta blockers provide good control of angina, have additional antihypertensive and antiarrhythmic effects, and may be beneficial in preventing sudden cardiac (arrhythmic) death and limiting myocardial infarct size, should these events supervene in the patient with angina. Disadvantages of beta blockers involve the occasional major side effects, including potential exacerbation of bronchospasm, peripheral vascular disease (PVD), diabetes, congestive heart failure and bradyarrhythmia, and frequent "nuisance" side effects. Calcium blockers control both exercise and rest angina and pose no problem in patients with bronchoconstriction, PVD, or diabetes. Disadvantages include need for frequent dosage, cost, and side effects. Long-acting nitrates have few major side effects and usually transient minor side effects, with little effect on quality of life.(ABSTRACT TRUNCATED AT 250 WORDS)