Optimal treatment strategy for managing stable ischemic heart disease is still a topic of debate. The purpose of this review by P. Vafaei et al. (Kaiser Permanente San Francisco Medical Center, California USA) is to discuss treatment strategies for managing stable coronary artery disease. It reviews findings based on the COURAGE trial (2007) and ISCHEMIA trial (2020.
For the authors, when applied to a broad population with stable CAD, evidence suggests there is no benefit to an initial invasive revascularisation strategy relative to optimal medical therapy alone.

There is very little data comparing plaque characteristics and wire-free physiological assessment in the target vessel in patients with stable angina versus acute coronary syndrome.

In this study, K. Dan et al. (USA)investigated the difference in plaque distribution between stable angina and NSTEMI, and explored the relationship between target vessel vulnerability by optical coherence tomography and wire-free functional assessment with quantitative flow ratio.

Dyslipidemia is known to be significantly associated with an increased risk of CAD and lipid-lowering strategy is the key approach for primary and secondary prevention.
In this cohort study, D. Kanda et al. (Kagoshima University, Japan) aimed to examine the clinical meaning of LDL-C ＜70 mg/dL and non-HDL-C ＜100 mg/dL on the occurrence of new lesions among Japanese patients with stable angina who were prescribed with strong statins.

Elevation of blood urea nitrogen (BUN) indicates renal dysfunction and is associated with increased mortality in cardiovascular diseases.
The authors investigated the relationship between the blood urea nitrogen concentration measured at hospital admission and the long-term all-cause mortality in 344 patients with stable angina pectoris, during a mean follow-up period of 8 yrs.

E. Navarese et al. (Nicolaus Copernicus University, Poland) presented the results of a new meta-analysis of revascularisation plus medical therapy versus medical therapy alone in patients with chronic coronary syndromes. A total of 19,806 patients with chronic coronary syndromes undergoing elective revascularisation from 25 randomised trials were pooled.

This article by Q. Radaideh et a. (Midwest Cardiovascular Research Foundation, USA) reviews the evidence on optimal medical therapy versus coronary revascularization in patients with stable ischaemic heart disease. The recently published ISCHEMIA trial has established the non-inferiority of medical therapy in comparison to coronary revascularisation in patients with moderate to severe ischaemia.

Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anaemia, polypharmacy and both increased bleeding/thrombotic risk.
In geriatric populations, acute coronary syndromes are associated with an increased frailty degree. Frail elderly patients are increasingly referred to cardiac rehabilitation programs after acute coronary syndromes.

Despite the increasing use, better logistics and improved methodology of interventional approaches for coronary reperfusion, the mortality and morbidity from acute myocardial infarction are still substantial. This is very clear when examining the real world data. This issue is complex: patients with acute myocardial infarction are typically advanced in age, have comorbidities and are receiving several medications. For them, it is necessary to consider not only infarct size reduction but also attenuation of coronary microvascular obstruction, as well as longer-term targets including infarct repair and reverse remodelling.

In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients.

T. J. Ford et al. (British Heart Foundation, UK) performed a multimodality investigation into the role of ET-1 and this gene variant in the pathogenesis of coronary microvascular dysfunction in 391 patients with symptoms and/or signs of ischaemia but no obstructive coronary artery disease.