Stable coronary artery disease – optimal medical therapy or revascularization?

The role of revascularization as a standard treatment of patients with stable angina still remains the subject of discussion and scientific research. Constant progress in surgical and percutaneous revascularization continues to bring the benefits of revascularization therapy to more and more patients. The aim of revascularization therapy is to improve the prognosis, symptoms and quality of life in patients with ischaemic heart disease. The assumption that revascularization is an alternative to medical therapy is a misconception. Both methods are complementary and the bases are optimal medical treatment and modification of risk factors. The decision of the optimal timing of revascularization as well as the choice of method should be individualized and depends on clinical circumstances, available methods, centre experience and patient preferences. In this paper we summarize the current state of knowledge on optimal medical treatment and revascularization in patients with stable angina. We mainly focus on indications and limitations of percutaneous intervention and surgical treatment and the choice of therapeutic strategy according to the latest clinical evidence and guidelines launched by scientific societies.