Approach to the Evaluation and Management of the Patient with Stable Ischemic Heart Disease Based on the Ischemia Trial - Flowchart
Approach to the Evaluation and Management of the Patient with Stable Ischemic Heart Disease Based on the Ischemia Trial - Flowchart Approach to the Evaluation and Management of the Patient with Approach to the Evaluation and Management of the Patient with
«Flowchart»

Stable angina

Stable angina

Stable angina

NYHA class I-II
CCS class I-II
preserved LV dysfunction

NYHA class I-II
CCS class I-II
preserved LV dysfunction



NYHA class I-II

NYHA class III-IV
CCS class III-IV
LV dysfunction

NYHA class III-IV
CCS class III-IV
LV dysfunction



NYHA class III-IV

Coronary angiography

Coronary angiography

Coronary angiography

End

End

End

Medical therapy

Medical therapy

Medical therapy

Resting WMA
moderate ischemia

Resting WMA
moderate ischemia


Resting WMA

No resting WMA
mild ischemia

No resting WMA
mild ischemia


No resting WMA

Refractory symptoms

Refractory symptoms

Refractory symptoms

Stress testing

Stress testing

Stress testing

High risk or LV dysfunction

High risk or LV dysfunction

High risk or LV dysfunction

Intermediate risk

Intermediate risk

Intermediate risk

Low risk

Low risk

Low risk

1 CABG is generally preferred because of known survival advantage over medical therapy alone; however, if the coronary lesions are not complex, PCI may offer similar results to CABG but with a higher need for future revascularizations.

1 CABG is generally preferred because of known survival advantage over medical therapy alone; however, if the coronary lesions are not complex, PCI may offer similar results to CABG but with a higher need for future revascularizations.

1 CABG is generally preferred because of known survival advantage over medical therapy alone; however, if the coronary lesions are not complex, PCI may offer similar results to CABG but with a higher need for future revascularizations.

1

2 PCI should be reserved for patients who have high-grade lesions, have severe ischemia, and are refractory to medical therapy.

2 PCI should be reserved for patients who have high-grade lesions, have severe ischemia, and are refractory to medical therapy.

2 PCI should be reserved for patients who have high-grade lesions, have severe ischemia, and are refractory to medical therapy.

2

Left main
CABG
PCI1

Left main
CABG
PCI1

Left main Left main

1 1 Left main

Severe 3 vessel
CABG
PCI1

Severe 3 vessel
CABG
PCI1

Severe 3 vessel Severe 3 vessel

1 1 Severe 3 vessel

Moderate 3 vessel
Mediacal Rx
PCI2

Moderate 3 vessel
Mediacal Rx
PCI2

Moderate 3 vessel Moderate 3 vessel

2 2 Moderate 3 vessel

1-2 vessel
Mediacal Rx
PCI2

1-2 vessel
Mediacal Rx
PCI2

1-2 vessel 1-2 vessel

2 2 1-2 vessel

No lesion
NICM
Microvascular disease
Coronary spasm

No lesion
NICM
Microvascular disease
Coronary spasm

No lesion No lesion


No lesion

CABG, coronary artery bypass grafting; CCS, Canadian Cardiovascular Society Classification (angina); NICM, nonischemic cardiomyopathy; NYHA, New York Heart Association; PCI, percutaneous coronary intervention; WMA, wall motion abnormality.

CABG, coronary artery bypass grafting; CCS, Canadian Cardiovascular Society Classification (angina); NICM, nonischemic cardiomyopathy; NYHA, New York Heart Association; PCI, percutaneous coronary intervention; WMA, wall motion abnormality.

CABG, coronary artery bypass grafting; CCS, Canadian Cardiovascular Society Classification (angina); NICM, nonischemic cardiomyopathy; NYHA, New York Heart Association; PCI, percutaneous coronary intervention; WMA, wall motion abnormality.