TITLE:
Conservative Approach Might Be the Strategy by Default in Stable Angina Patients: A Case Report
AUTHORS:
Serigne Cheikh Tidiane Ndao, Mame Madjiguene Ka, Djibril Marie Ba, Khadidiatou Dia, Mouhamed Chérif Mboup, Pape Diadie Fall
KEYWORDS:
Stable Angina, Chronic Coronary Syndrome, Conservative Treatment, Case Report
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.10 No.11,
November
25,
2020
ABSTRACT: Management of stable angina is still a matter of
debate. Whether a conservative or invasive approach is better
remains unclear. Even though recent large-scale randomized trials depict the conservative strategy as safe
and efficient. In this report, we present
a case of a 53-year-old male patient with cardiovascular risk factors of hypertension
and hypercholesterolemia. He complained about typical chest pain at exertion. The
coronary angiogram (CA) revealed severe stenosis of the proximal
left anterior descending artery (LAD) ostium. After heart team discussion, coronary
artery bypass graft (CABG) was advocated. However, due to a lack of means, the CABG
was postponed. Meanwhile, he was managed with guideline-based medical therapy. In addition, he exercised
regularly and adopted a healthy diet. Evolution was favorable with excellent symptoms
control. A regular follow-up was organized with his cardiologist. A new CA before
an eventual CABG six years later showed a significant plaque volume regression of
the proximal LAD. We decided to continue conservative management. The stress echocardiogram
to assess symptoms and exercise tolerance was normal. Our patient was sent to surgery on top of optimal medical
therapy even though angioplasty was a good indication and was feasible. However,
while he was struggling to afford the CABG procedure, he adopted a very healthy
lifestyle along with medical therapy. Six years later, the result of that approach
was without appeal, suggesting and reinforcing the conservative management of stable
heart disease over invasive strategy. The recent ISCHEMIA trial is a major argument
supporting that approach.