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| ==Overview== | | ==Overview== |
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| The average mortality in patients with stable angina ranges from 1-3%. However, the prognosis varies widely depending on various factors such as the duration and severity of symptoms, resting [[ECG]] abnormalities, abnormal left ventricular function and associated comorbidities.<ref>Predicting prognosis in stable angina--results from the Euro heart survey of stable angina: prospective observational study. Daly CA, De Stavola B, Sendon JL, Tavazzi L, Boersma E, Clemens F, Danchin N, Delahaye F, Gitt A, Julian D, Mulcahy D, Ruzyllo W, Thygesen K, Verheugt F, Fox KM; Euro Heart Survey Investigators. BMJ. 2006 Feb 4;332(7536):262-7. Epub 2006 Jan 13 PMID: 16415069</ref> Given the variability in prognosis, it is important to risk stratify patients. Risk stratification is based on four patient characteristics: | | *The average mortality in patients with stable angina ranges from '''1-3%'''. However, the prognosis varies widely depending on various factors such as the duration and severity of symptoms, resting [[ECG]] abnormalities, abnormal left ventricular function and associated comorbidities.<ref name="pmid16415069">Daly CA, De Stavola B, Sendon JL, Tavazzi L, Boersma E, Clemens F et al. (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16415069 Predicting prognosis in stable angina--results from the Euro heart survey of stable angina: prospective observational study.] ''BMJ'' 332 (7536):262-7. [http://dx.doi.org/10.1136/bmj.38695.605440.AE DOI:10.1136/bmj.38695.605440.AE] PMID: [http://pubmed.gov/16415069 16415069]</ref> |
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| | *Given the variability in prognosis, it is important to risk stratify patients. '''Risk stratification is based on four patient characteristics:''' |
| # Left ventricular function, which is the strongest predictor of long term survival | | # Left ventricular function, which is the strongest predictor of long term survival |
| # Extent of atherosclerosis in the coronary arteries (single vessel disease vs multivessel disease) | | # Extent of [[atherosclerosis]] in the coronary arteries (single vessel disease vs multivessel disease) |
| # Evidence of a recent coronary plaque rupture ([[acute coronary syndrome]]) | | # Evidence of a recent coronary plaque rupture ([[acute coronary syndrome]]) |
| # Overall health and presence of other co-morbidities. | | # Overall health and presence of other co-morbidities. |
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| An initial scoring system was proposed by the Framingham Heart Study group to predict 10 year risk for patients with [[CAD]] based upon the patient's age, sex, total [[cholesterol]], presence of [[hypertension]] and history of [[smoking]] and [[diabetes]]. The presence of other peripheral vascular diseases is also used to risk stratify patients. | | *An initial scoring system was proposed by the '''Framingham Heart Study group''' to predict 10 year risk for patients with [[CAD]] based upon: |
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| | ::*patient's age, sex, |
| | ::*total [[cholesterol]], |
| | ::*presence of [[hypertension]] and |
| | ::*history of [[smoking]] and [[diabetes]]. |
| | ::*presence of other [[peripheral vascular diseases]] is also used to risk stratify patients. |
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| ==Risk Stratification of Chronic Stable Angina== | | ==Risk Stratification of Chronic Stable Angina== |
| | You can read in greater detail about each of the topic by clicking below on the link for that topic: |
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| ===ECG===
| | *[[Chronic stable angina risk stratification electrocardiogram/chest x-ray|Electrocardiogram / Chest X-Ray]] |
| | | *[[Chronic stable angina risk stratification rest left ventricular function|Assessment of Resting LV Function]] |
| The presence of [[ECG]] abnormalities at rest puts the patient at higher risk than the absence of ECG abnormalities at rest. [[ECG]] abnormalities at rest may include left ventricular hypertrophy ([[LVH]]) by ECG criteria, persistent ST-T wave inversions in V1-V3, Q waves in multiple leads or an R wave in V1 (a "posterior" q wave), [[bundle branch block]]s and atrial or ventricular [[arrythmias]].
| | *Exercise testing for Risk Stratification and Prognosis: |
| | | ::*[[Chronic stable angina risk stratification exercise testing|In Patients With an Intermediate or High Probability of CAD]] |
| ===Chest X-ray===
| | ::*[[Chronic stable angina risk stratification cardiac stress imaging in patients who are able to exercise|In patients Who Are Able To Exercise]] |
| The presence of [[cardiomegaly]] or pulmonary vascular congestion on chest X-ray is also associated with a poor prognosis.
| | ::*[[Chronic stable angina risk stratification cardiac stress imaging in patients who are unable to exercise|In patients Who Are Unable To Exercise]] |
| | | ::*[[Chronic stable angina risk stratification coronary angiography|By Coronary Angiography and Left Ventriculography]] |
| ===Left Ventricular Function===
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| The indications for assessing LV function are not limited to patients with evidence of [[congestive heart failure]] or valvular dysfunction, but also includes patients with documented [[MI]] or an [[ECG]] showing Q waves(suggestive of an old MI). A resting or exercise LV ejection fraction (LVEF) of less than 35% is associated with a significantly higher mortality than a normal LVEF. In patients with three-vessel coronary artery disease, the presence of an ejection fraction of less than 50% or clinical evidence of [[heart failure]] is associated with almost three times higher mortality than that in patients with normal left ventricular function and a similar extent of CAD.<ref>{{cite book |last= Braunwald |first= Eugene. |coauthors= Lee Goldman|title= [[Primary Cardiology]]|chapter=25 |publisher= [[Saunders]] |year= 2003|month= April|isbn= 0-7216-9444-6}}</ref>
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| [[Echocardiography]] is the best initial tool for obtaining an estimate of left ventricular function, both systolic and diastolic. In addition, echocardiography also provides information regarding associated valvular dysfunction and [[pulmonary artery pressure]]s. This information can in turn be used to select or modify the treatment regimen for the patient.
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| ==ACC / AHA Guidelines- Measurement of rest LV function by echocardiography or radionuclide angiography (DO NOT EDIT)<ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980</ref>==
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| {{cquote|
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| ===Class I===
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| '''1.''' [[Echocardiography]] or [[radionuclide angiography]] (RNA) in patients with a history of prior [[MI]], pathological Q waves, or symptoms or signs suggestive of [[heart failure]] to assess [[LV function]]. ''(Level of Evidence: B)''
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| '''2.'''[[Echocardiography]] in patients with a [[systolic murmur]] suggesting [[mitral regurgitation]] to assess its severity and etiology. ''(Level of Evidence: C)''
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| '''3.'''[[Echocardiography]] or RNA in patients with complex [[ventricular arrhythmia]]s to assess [[LV function]]. ''(Level of Evidence: B)''
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| ===Class III===
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| '''1.''' Routine periodic reassessment of stable patients for whom no new change in therapy is contemplated. ''(Level of Evidence: C)''
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| '''2.''' Patients with a normal [[ECG]], no history of [[MI]], and no symptoms or signs suggestive of [[heart failure]]. ''(Level of Evidence: B)''}}
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| ==Exercise testing for Risk Stratification and Prognosis==
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| ==ACC / AHA Guidelines- Risk Assessment and Prognosis in Patients With an Intermediate or High Probability of CAD (DO NOT EDIT)<ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980</ref>==
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| {{cquote|
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| ===Class I===
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| '''1.''' Patients undergoing initial evaluation. (Exceptions are listed below in classes IIb and III.) ''(Level of Evidence: B)''
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| '''2.''' Patients after a significant change in cardiac symptoms. ''(Level of Evidence: C)''
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| ===Class IIb===
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| '''1.''' Patients with the following [[ECG]] abnormalities:
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| :a. Preexcitation ([[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White]]) syndrome. ''(Level of Evidence: B)'' | |
| :b. Electronically paced ventricular rhythm. ''(Level of Evidence: B)''
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| :c. More than 1 mm of rest ST depression. ''(Level of Evidence: B)''
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| :d. Complete [[left bundle-branch block]]. ''(Level of Evidence: B)''
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| '''2.''' Patients who have undergone [[cardiac catheterization]] to identify [[ischemia]] in the distribution of a coronary lesion of borderline severity. ''(Level of Evidence: C)''
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| '''3.'''[[Revascularization|Postrevascularization]] patients who have a significant change in anginal pattern suggesting [[ischemia]]. ''(Level of Evidence: C)''
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| ===Class III===
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| '''1.''' Patients with severe [[comorbidity]] likely to limit life expectancy or prevent [[revascularization]]. ''(Level of Evidence: C)''}}
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| ==ACC / AHA Guidelines- Cardiac Stress Imaging for Risk Stratification of Patients With Chronic Stable Angina Who Are Able to Exercise (DO NOT EDIT)<ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980</ref>==
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| {{cquote|
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| ===Class I===
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| '''1.''' Exercise myocardial perfusion imaging or exercise [[echocardiography]] to identify the extent, severity, and location of [[ischemia]] in patients who do not have [[left bundle-branch block]] or an electronically paced ventricular rhythm and have either an abnormal rest [[ECG]] or are using [[digoxin]]. ''(Level of Evidence: B)''
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| '''2.'''[[Dipyridamole]] or [[adenosine]] myocardial perfusion imaging in patients with [[left bundle-branch block]] or electronically paced ventricular rhythm. ''(Level of Evidence: B)''
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| '''3.''' Exercise myocardial perfusion imaging or exercise [[echocardiography]] to assess the functional significance of coronary lesions (if not already known) in planning [[PTCA]]. ''(Level of Evidence: B)''
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| ===Class IIb===
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| '''1.''' Exercise or [[dobutamine]] [[echocardiography]] in patients with [[left bundle-branch block]]. ''(Level of Evidence: C)''
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| '''2.''' Exercise, [[dipyridamole]], [[adenosine]] myocardial perfusion imaging, or exercise or [[dobutamine]] [[echocardiography]] as the initial test in patients who have a normal rest [[ECG]] and are not taking [[digoxin]]. ''(Level of Evidence: B)''
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| ===Class III===
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| '''1.''' Exercise myocardial perfusion imaging in patients with left [[bundle-branch block]]. ''(Level of Evidence: C)''
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| '''2.''' Exercise, [[dipyridamole]], [[adenosine]] myocardial perfusion imaging, or exercise or [[dobutamine]] [[echocardiography]] in patients with severe [[comorbidity]] likely to limit life expectation or prevent [[revascularization]]. ''(Level of Evidence: C)''}}
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| ==ACC / AHA Guidelines- Cardiac Stress Imaging as the Initial Test for Risk Stratification of Patients With Chronic Stable Angina Who Are Unable to Exercise (DO NOT EDIT)<ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980</ref>==
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| {{cquote|
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| ===Class I===
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| '''1.'''[[Dipyridamole]] or [[adenosine]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] to identify the extent, severity, and location of [[ischemia]] in patients who do not have [[left bundle-branch block]] or electronically paced ventricular rhythm. ''(Level of Evidence: B)''
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| '''2.'''[[Dipyridamole]] or [[adenosine]] myocardial perfusion imaging in patients with [[left bundle-branch block]] or electronically paced ventricular rhythm. ''(Level of Evidence: B)''
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| '''3.'''[[Dipyridamole]] or [[adenosine]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] to assess the functional significance of coronary lesions (if not already known) in planning [[PTCA]]. ''(Level of Evidence: B)''
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| ===Class IIb===
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| '''1.'''[[Dobutamine]] [[echocardiography]] in patients with [[left bundle-branch block]]. ''(Level of Evidence: C)''
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| ===Class III===
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| '''1.'''[[Dipyridamole]] or [[adenosine]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] in patients with severe [[comorbidity]] likely to limit life expectation or prevent [[revascularization]]. ''(Level of Evidence: C)''}}
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| ==ACC / AHA Guidelines- Coronary Angiography and Left Ventriculography (DO NOT EDIT)<ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980</ref>==
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| {{cquote|
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| ===Class I===
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| '''1.''' Patients with disabling (Canadian Cardiovascular Society (CCS) classes III and IV) chronic stable angina despite medical therapy. ''(Level of Evidence: B)''
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| '''2.''' Patients with high-risk criteria on noninvasive testing regardless of anginal severity. ''(Level of Evidence: B)''
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| '''3.''' Patients with [[angina]] who have survived [[sudden cardiac death]] or serious [[ventricular arrhythmia]]. ''(Level of Evidence: B)''
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| '''4.''' Patients with [[angina]] and symptoms and signs of [[congestive heart failure]]. ''(Level of Evidence: C)''
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| '''5.''' Patients with clinical characteristics that indicate a high likelihood of severe [[CAD]]. ''(Level of Evidence: C)''
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| ===Class IIa===
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| '''1.''' Patients with significant [[LV dysfunction]] (ejection fraction <45%), CCS class I or II angina, and demonstrable [[ischemia]] but less than high-risk criteria on noninvasive testing. ''(Level of Evidence: C)''
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| '''2.''' Patients with inadequate prognostic information after noninvasive testing. ''(Level of Evidence: C)''
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| ===Class IIb===
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| '''1.''' Patients with CCS class I or II [[angina]], preserved [[LV function]] (ejection fraction >45%), and less than high-risk criteria on noninvasive testing. ''(Level of Evidence: C)''
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| ===Class III===
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| '''1.''' Patients with CCS class I or II [[angina]] who respond to medical therapy and have no evidence of [[ischemia]] on noninvasive testing. ''(Level of Evidence: C)''
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| '''2.''' Patients who prefer to avoid [[revascularization]]. ''(Level of Evidence: C)''}}
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| ==Asymptomatic patients==
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| ==ACC / AHA Guidelines- Noninvasive Testing for the Diagnosis of Obstructive CAD and Risk Stratification in Asymptomatic Patients (DO NOT EDIT)<ref name="Gibbons2">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SC Jr; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003 Jan 7; 107 (1): 149-58. PMID 12515758 </ref>==
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| {{cquote|
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| ===Class IIb===
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| '''1.''' Exercise [[ECG]] testing without an imaging modality in asymptomatic patients with possible [[myocardial ischemia]] on [[ambulatory ECG]] ([[AECG]]) monitoring or with severe [[coronary calcification]] on [[EBCT]] in the absence of one of the following [[ECG]] abnormalities:
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| :a. Preexcitation ([[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White]]) syndrome ''(Level of Evidence: C)''
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| :b. Electronically paced ventricular rhythm ''(Level of Evidence: C)''
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| :c. More than 1 mm of ST depression at rest ''(Level of Evidence: C)''
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| :d. Complete [[left bundle-branch block]]. ''(Level of Evidence: C)''
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| '''2.''' Exercise perfusion imaging or exercise [[echocardiography]] in asymptomatic patients with possible [[myocardial ischemia]] on [[AECG]] monitoring or with severe [[coronary calcification]] on [[EBCT]] who are able to exercise and have one of the following baseline [[ECG]] abnormalities:
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| :a. Preexcitation ([[Wolff-Parkinson-White syndrome|Wolff-Parkinson-White]]) syndrome ''(Level of Evidence: C)''
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| :b. More than 1 mm of ST depression at rest. ''(Level of Evidence: C)''
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| '''3.'''[[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging in patients with severe [[coronary calcification]] on [[EBCT]] but with one of the following baseline [[ECG]] abnormalities:
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| :a. Electronically paced ventricular rhythm ''(Level of Evidence: C)'' | |
| :b. [[Left bundle-branch block]]. ''(Level of Evidence: C)'' | |
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| '''4.'''[[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] in patients with possible [[myocardial ischemia]] on [[AECG]] monitoring or with [[coronary calcification]] on [[EBCT]] who are unable to exercise. ''(Level of Evidence: C)''
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| '''5.''' Exercise [[myocardial perfusion]] imaging or exercise [[echocardiography]] after exercise [[ECG]] testing in asymptomatic patients with an intermediate-risk or high-risk Duke treadmill score. ''(Level of Evidence: C)''
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| '''6.'''[[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] after exercise [[ECG]] testing in asymptomatic patients with an inadequate exercise [[ECG]]. ''(Level of Evidence: C)''
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| ===Class III===
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| '''1.''' Exercise [[ECG]] testing without an imaging modality in asymptomatic patients with possible [[myocardial ischemia]] on [[AECG]] monitoring or with [[coronary calcification]] on [[EBCT]] but with the baseline [[ECG]] abnormalities listed under Class IIb1 above. ''(Level of Evidence: B)''
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| '''2.''' Exercise [[ECG]] testing without an imaging modality in asymptomatic patients with an established diagnosis of [[CAD]] owing to prior [[MI]] or [[coronary angiography]]; however, testing can assess functional capacity and prognosis. ''(Level of Evidence: B)''
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| '''3.''' Exercise or [[dobutamine]] [[echocardiography]] in asymptomatic patients with [[left bundle-branch block]]. ''(Level of Evidence: C)''
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| '''4.'''[[Adenosine]] or [[dipyridamole]] myocardial perfusion imaging or [[dobutamine]] [[echocardiography]] in asymptomatic patients who are able to exercise and who do not have [[left bundle-branch block]] or electronically paced ventricular rhythm. ''(Level of Evidence: C)''
| | ==Risk Stratification of Chronic Stable Angina in Asymptomatic Patients== |
| | You can read in greater detail about each of the topic by clicking below on the link for that topic: |
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| '''5.''' Exercise myocardial perfusion imaging, exercise [[echocardiography]], [[adenosine]] or [[dipyridamole]] myocardial perfusion imaging, or [[dobutamine]] [[echocardiography]] after exercise [[ECG]] testing in asymptomatic patients with a low-risk Duke treadmill score. ''(Level of Evidence: C)''}}
| | *[[Chronic stable angina risk stratification in asymptomatic patients by noninvasive testing|Risk Stratification by Noninvasive Testing]] |
| | | *[[Chronic stable angina risk stratification in asymptomatic patients by coronary angiography|Coronary Angiography in Asymptomatic Patients]] |
| ==ACC / AHA Guidelines- Coronary Angiography for Risk Stratification in Asymptomatic Patients (DO NOT EDIT)<ref name="Gibbons2">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SC Jr; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003 Jan 7; 107 (1): 149-58. PMID 12515758 </ref>==
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| {{cquote|
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| ===Class IIa===
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| '''1.''' Patients with high-risk criteria that suggest [[ischemia]] on noninvasive testing. ''(Level of Evidence: C)''
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| ===Class IIb===
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| '''1.''' Patients with inadequate prognostic information after noninvasive testing. ''(Level of Evidence: C)''
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| ===Class III===
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| '''1.''' Patients who prefer to avoid [[revascularization]]. ''(Level of Evidence: C)''}}
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| ==See Also== | | ==See Also== |
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| ==Sources== | | ==Sources== |
| *The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="Gibbons1"> Gibbons RJ, Chatterjee K, Daley J, et al. ACC/AHA/ACP–ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina). Circulation. 1999; 99: 2829–2848. PMID 10351980</ref> | | *Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 }} </ref> |
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| | *The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. PMID: [http://pubmed.gov/10351980 10351980]</ref> |
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| *TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="Gibbons2">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Fihn SD, Fraker TD Jr, Gardin JM, O'Rourke RA, Pasternak RC, Williams SV, Gibbons RJ, Alpert JS, Antman EM, Hiratzka LF, Fuster V, Faxon DP, Gregoratos G, Jacobs AK, Smith SC Jr; American College of Cardiology; American Heart Association Task Force on Practice Guidelines. Committee on the Management of Patients With Chronic Stable Angina. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation. 2003 Jan 7; 107 (1): 149-58. PMID 12515758 </ref> | | *TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58. PMID: [http://pubmed.gov/12515758 12515758]</ref> |
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| *The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="Fraker"> Fraker TD Jr, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, Ferguson TB Jr, Gardin JM, O'Rourke RA, Williams SV, Smith SC Jr, Jacobs AK, Adams CD, Anderson JL, Buller CE, Creager MA, Ettinger SM, Halperin JL, Hunt SA, Krumholz HM, Kushner FG, Lytle BW, Nishimura R, Page RL, Riegel B, Tarkington LG, Yancy CW; American College of Cardiology; American Heart Association; American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group. 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation. 2007 Dec 4; 116 (23): 2762-72. Epub 2007 Nov 12. PMID 17998462 </ref> | | *The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.187930 DOI:10.1161/CIRCULATIONAHA.107.187930] PMID: [http://pubmed.gov/17998462 17998462]</ref> |
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| ==References== | | ==References== |