A 55-year-old woman with stable angina undergoes coronary angiography showing 65% stenosis of the LAD. Her symptoms are well controlled on atenolol, amlodipine, and sublingual nitrate PRN. According to evidence-based management of stable ischemic heart disease, the next step is:
- A Continue and optimize guideline-directed medical therapy ✓
- B Immediate percutaneous coronary intervention (PCI)
- C Urgent coronary artery bypass grafting
- D Add ranolazine and reassess in 1 month
Correct answer: A. Continue and optimize guideline-directed medical therapy
Explanation
For stable ischemic heart disease with non-obstructive to moderate coronary artery disease and well-controlled symptoms, the ISCHEMIA trial demonstrated that an initial conservative strategy with optimized guideline-directed medical therapy (GDMT) is non-inferior to revascularization for reduction of ischemic events. PCI or CABG is reserved for refractory symptoms, significant left main disease, or reduced LV function. The current patient is already symptom-controlled on medical therapy.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.