Chronic Coronary Syndrome: Medical Therapy or Myocardial Revascularization?

The best therapeutic strategy for chronic coronary syndrome (CCS) is still controversial. The lack of contemporaneity of medical treatment in many randomized clinical trials prior to the large-scale use of statins, antiplatelet agents, anti-diabetic drugs with cardiovascular protection, and changes in life habits with well-established goals limits the applicability of such studies in current clinical practice. Medical treatment is the only therapeutic option capable of reducing atherosclerotic damage and, therefore, of acting effectively in preventing the progression of this disease. The purpose of this brief review is to critically analyze the main contemporary studies that confront medical treatment with myocardial revascularization in CCS. randomized trial, the addition of evolocumab, a proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor, together with statins, reduced the percent of atheroma volume (64.3% vs 47.3%) and the total atheroma volume (61.5% vs 48.9%). 13 Two recent reports unequivocally show how medical therapy can promote regression of CAD. Keraliya et al. reported the improvement of ischemia and regression of coronary atherosclerotic disease assessed by coronary CT angiography in a patient studied over a four-year interval, 15 whereas Kunhali et al. demonstrated the disappearance of angina and the angiographic regression of coronary artery obstruction seven years after the beginning of medical treatment. 16 Reinforcement for the role of medical treatment in the prognosis of this disease comes from the results of a retrospective, population-based cohort study that included 29,047 residents in the Italian Lombardy region, aged 65 years or older, who were receiving uninterrupted