Open AccessPOINT: A Prescription to Decrease Left Ventricular Function
Author(s) -
Ellestad Myrvin H.
Publication year - 2009
Publication title -
preventive cardiology
Language(s) - English
Resource type - Journals
eISSN - 1751-7141
pISSN - 1520-037X
DOI - 10.1111/j.1751-7141.2009.00045.x
Subject(s) - medicine , angina , cardiology , ventricular function , randomized controlled trial , ischemia , incidence (geometry) , surgery , myocardial infarction , physics , optics
The Courage Trial, published in 2007, has significantly reduced the incidence of treating stable angina with angioplasty. The investigators randomized 2297 patients with documented cardiac ischemia to conservative or invasive therapy and concluded that there was no difference in major events during a follow‐up of 2.5 to 7 years and that the urge to open the narrowed artery was unjustified. Over the years it has been well documented by myocardial biopsy that repeated ischemic episodes result in replacement of myocardial cells by fibrous tissue, loss of mitochondria, and deterioration of left ventricular function. Ischemic episodes often occur in the absence of angina so that it is impossible to determine whether the therapy is reducing the magnitude or duration of the process. Also, in their study, 32% of the conservatively treated patients crossed over to invasive. The evidence indicated that conservative treatment may result in a progressive decrease in left ventricular function.