Therapy For Stable Angina Research Articles

Percutaneous coronary intervention versus medical therapy in stable angina: a matched cohort study

ObjectiveIt is uncertain whether percutaneous coronary intervention (PCI) in addition to optimal medical therapy (OMT) can reduce adverse clinical events in the long term as compared with OMT alone in...

Tongxinluo capsule in combination with conventional therapies for stable angina pectoris: A meta-analysis and systematic review.

This study aimed to assess the efficacy and safety of Tongxinluo capsule (TXLC) in combination with conventional therapies for treating stable angina pectoris (SAP) through a comprehensive meta-analysis and systematic review. We conducted a systematic search of the China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Embase, and CENTRAL databases for randomized controlled trials investigating the use of TXLC as adjuvant therapy for SAP published up to June 2023. The Cochrane Handbook was used to evaluate the risk of bias. Meta-analysis was performed using Review Manager 5.4.1, and publication bias was assessed using Begg test and Egger test in the Stata SE 12.0 software. GRADEpro was used to assess the quality of the evidence. This meta-analysis included 26 randomized controlled trials with a total of 2352 patients. TXLC co-administration demonstrated significant reduction in angina attack frequency (mean difference (MD) -0.91, 95% confidence interval (CI) -0.97 to -0.84, P < .00001) and duration (MD -1.71, 95% CI -2.24 to -1.19, P < .00001), decreased use of nitroglycerin tablets (MD -6.28, 95% CI -7.16 to -5.41, P < .00001), lowered C-reactive protein (MD -1.19, 95% CI -1.35 to -1.03, P < .00001) and low-density lipoprotein cholesterol levels (MD -0.68, 95% CI -0.86 to -0.51, P < .00001). TXLC co-administration did not increase gastrointestinal reactions (RR 1.17, 95% CI 0.38 to 3.57, P = .78). The Begg test and Egger test results indicated no publication bias. The evidence quality was rated as very low for frequency of angina attack, duration of angina attack, and nitroglycerin usage, and low for C-reactive protein, low-density lipoprotein cholesterol levels, and gastrointestinal reaction events. This meta-analysis supports TXLC as a beneficial adjunct treatment for SAP.

Современная симптоматическая терапия стабильной стенокардии напряжения: что выбрать?

Ишемическая болезнь сердца — вторая по распространенности после артериальной гипертензии сердечно-сосудистая патология в мире и Украине, а потому ведение пациентов с артериальной гипертензией и ишемической болезнью сердца — задача не только врача-кардиолога, но и врача-терапевта на любом из этапов оказания медицинской помощи. Симптоматическая терапия стабильной стенокардии, предусматривающая купирование и предупреждение приступов загрудинной боли (или эквивалентов стенокардии) у пациентов с ишемической болезнью сердца, остается актуальной стратегией в случаях, когда приступы стенокардии отмечаются на фоне оптимально подобранной терапии, проведение реваскуляризации невозможно, а дальнейшая титрация препаратов первого ряда осложняется из-за риска побочных эффектов. Ведущее место среди препаратов второй линии, имеющих противоишемический эффект и применяющихся с целью устранения приступов стенокардии, занимают нитраты короткого и пролонгированного действия, которые обеспечивают коронарную артериальную вазодилатацию благодаря действию активного компонента оксида азота. Чаще всего назначают пролонгированную форму изосорбида динитрата для профилактики приступов стенокардии. Удобный режим дозирования обеспечивает, с одной стороны, пролонгированный эффект, а с другой — помогает снизить риск развития толерантности к нитратам. Однако на практике можно наблюдать появление такого осложнения, как головная боль. С целью предупреждения этого довольно часто практический врач делает выбор в пользу молсидомина. Однако было доказано, что антиангинальная эффективность этого препарата значительно меньше, чем пролонгированных форм нитратов. В Украине молсидомин назначают не в той дозе, для которой был доказан антиангинальный эффект (16 мг), а в значительно более низкой. Было показано, что метаболит молсидомина линсидомин характеризуется значительной токсичностью, поэтому во многих странах мира от использования молсидомина отказались. Использование пролонгированных форм нитратов — наиболее оптимальная тактика.

Metabolic signatures of cholesterol biosynthesis and absorption in patients with coronary artery disease

Due to the biochemical importance of cholesterol homeostasis in cardiovascular disease (CVD), this study was aimed to identify metabolic signatures of serum sterols according to atherosclerotic CVD severity. Biogically active free cholesterol and its 11 analogues in serum samples obtained from subjects who underwent cardiovascular intervention were quantitatively evaluated by gas chromatography-mass spectrometry (GCMS). Study groups were divided by 29 patients with stable angina (SA), 35 patients with acute coronary syndrome (ACS), and 41 controls. In all subjects, serum levels of cholesterol and its upstream precursors of 7-dehydrocholesterol, lathosterol, and lanosterol were closely associated with CVD risk factors, such as total cholesterol, low-density lipoprotein cholesterol (LDL-C), and LDL-C/high-density lipoprotein cholesterol (HDL-C) ratio (r = 0.407 ∼ 0.684, P < 0.03 for all). Metabolic ratios of lathosterol/cholesterol (control = 55.75 ± 34.34, SA = 51.04 ± 34.93, ACS = 36.52 ± 22.00; P < 0.03) and lanosterol/cholesterol (control = 12.27 ± 7.43, SA = 10.97 ± 9.13, ACS = 8.01 ± 5.82; P < 0.03), were remarkably decreased. Both metabolic ratios and individual concentrations of lathosterol and lanosterol were also decreased in subjects with statin treatment than those in the control group without statin treatment (P < 0.05 for all), whereas three metabolic ratios of dietary sterols (sitosterol, campesterol, and stigmasterol) to free cholesterol were increased after statin therapy (P < 0.05 for all) in both SA and ACS groups. The present metabolic signatures suggest that both lathosterol/cholesterol and lanosterol/cholesterol ratios corresponding to cholesterol biosynthesis may reflect statin response. Individual dietary sterols to cholesterol ratios resulted in higher intestinal cholesterol absorption after statin therapy.

Cardiovascular events as a № 1 killer. Pharmacotherapy of coronary heart disease

Cardiovascular events as a № 1 killer. Pharmacotherapy of coronary heart disease

Needle-embedding therapy combined with basic treatment for stable angina pectoris

ObjectiveTo clarify the clinical efficacy of needle-embedding therapy for stable angina pectoris. MethodsSeventy-six patients with stable angina pectoris were divided into needle-embedding therapy group (group A) and basic treatment group (group B) according to the random number table, with 38 patients in each group. Needle-embedding therapy combined with basic treatment was adopted in group A, and needle-embedding was given once every other day, the needles were retained for 24 h each time and three times of treatment were given each week. basic treatment was applied solely in group B. Four weeks of treatment which means one course were given in two groups, efficacy observation and evaluation were carried out after 1 course of treatment . ResultsAfter treatment, the total effective rate of clinical efficacy was 89.47% in group A and 71.05% in group B (p < 0.05), and the total effective rate of electrocardiograph (ECG) efficacy was 84.21% in group A and 63.16% in group B (p < 0.05). After treatment, the score of limitation of motion, score of the stable state of angina pectoris and the score of angina pectoris attack in group A increased by 0.7%, 34.5% and 16.9% respectively when compared with the scores before treatment (t = 1.623, p < 0.01; t = 3.867, p < 0.01; t = 1.958, p < 0.05), and according to the comparison of the score of satisfaction with treatment and the score of disease perception before and after treatment, the difference was not statistically significant (t = 4.972, p > 0.05; t = 0.999, p > 0.05). According to the comparison of the score of limitation of motion, score of angina pectoris attack, score of satisfaction with treatment and the score of disease perception in group B before and after treatment, the differences were not statistically significant (t = 1.726, p > 0.05; t = 1.594, p > 0.05; t = 4.385, p > 0.05; t = 0.999, p > 0.05). The score of the stable state of angina pectoris increased by 4.9% (t = 1.780, p < 0.05). ConclusionNeedle-embedding in acupoint therapy can effectively improve the clinical efficacy, ECG efficacy and the score of Seattle angina questionnaire (SAQ) of stable angina pectoris.

STUDY OF CARDIOPROTECTIVE AND ANTI-ISCHEMIC EFFECTIVENESS OF STANDARD TREATMENT FOR ISCHEMIC HEART DISEASE WITH ADDITION OF PERINDOPRIL ARGININE, IN OLDER PATIENTS

Aim. To evaluate the cardioprotective, anti-ischemic and vasoprotective effectiveness of perindopril arginine (Prestarium А®, Les Laboratories Servier, France) in stable angina patients of older age, after myocardial infarction (MI). Material and methods. Totally, 68 patients of older age (72±12 y.) included, with stable angina, who had MI. All patients underwent echocardiography with dopplerographic analysis of transmitral blood flow, Holter monitoring of ECG, ultrasound dopplerography of carotid arteries. Patients from the 1 group (33 persons) were taking standard therapy of stable angina. Patients from the 2 group (n=35) as addition were taking PA 10 mg daily. Results. By the data of Holter ECG, in patients of both groups there was decrease of mean frequency of angina attacks (by 76,4% in 1 group, by 86,3% in 2), need for nitroglycerin use (by 68,7% and 71,3%, resp.), frequency of ischemia episodes (by 35,5% and 55,6%, resp.), total daily duration of ischemia (50,3% and 49,7%), depth of ischemic ST segment depression (44,6% and 58,6%, resp.). There was more prominent significant decrease of the parameters mentioned, in patients taking Prestarium А®. Also, in the 2 group patients the decrease of intima-media thickness of the right and left common carotid arteries was more significant than in the 1 group. In 2 group there was increase of relation of the peak velocities of the left ventricle (LV) filling in early phase of diastole and in atrium systole phase, by 14,6% and decrease of end-diastolic size of the LV by 10,9%. Conclusion. Usage of Prestarium А® in stable angina patients of older age, after MI, was effective, which presented with the decrease of the frequency and intensity of angina attacks, slowing of desadaptive LV remodeling processes, improvement of clinical condition, decrease of supraventricular rhythm disorders, positive influence on the heart and vessels, hence having vasoprotective and cardioprotective effect.

Traditional Chinese medicine for stable angina pectoris via TCM pattern differentiation and TCM mechanism: study protocol of a randomized controlled trial

BackgroundStable angina pectoris is experienced as trans-sternal or retro-sternal pressure or pain that may radiate to the left arm, neck or back. Although available evidence relating to its effectiveness and mechanism are weak, traditional Chinese medicine is used as an alternative therapy for stable angina pectoris. We report a protocol of a randomized controlled trial using traditional Chinese medicine to investigate the effectiveness, mechanism and safety for patients with stable angina pectoris.Methods/DesignThis is a north-east Chinese, multi-center, multi-blinded, placebo-controlled and superiority randomized trail. A total of 240 patients with stable angina pectoris will be randomly assigned to three groups: two treatment groups and a control group. The treatment groups will receive Chinese herbal medicine consisting of Yi-Qi-Jian-Pi and Qu-Tan-Hua-Zhuo granule and Yi-Qi-Jian-Pi and Qu-Tan-Hua-Yu granule, respectively, and conventional medicine. The control group will receive placebo medicine in addition to conventional medicine. All 3 groups will undergo a 12-week treatment and 2-week follow-up. Four visits in sum will be scheduled for each subject: 1 visit each in week 0, week 4, week 12 and week 14. The primary outcomes include: the frequency of angina pectoris attack; the dosage of nitroglycerin; body limited dimension of Seattle Angina Questionnaire. The secondary outcomes include: except for the body limited dimension of SAQ, traditional Chinese medicine pattern questionnaire and so on. Therapeutic mechanism outcomes, safety outcomes and endpoint outcomes will be also assessed.DiscussionThe primary aim of this trial is to develop a standard protocol to utilize high-quality EBM evidence for assessing the effectiveness and safety of SAP via TCM pattern differentiation as well as exploring the efficacy mechanism and regulation with the molecular biology and systems biology.Trial registrationClinical Trials Registration: ChiCTR-TRC-13003608, registered 18 June 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/1745-6215-15-422) contains supplementary material, which is available to authorized users.

Targeting Myocardial Metabolism for the Treatment of Stable Angina

The goals of pharmacological treatment of stable angina pectoris are to improve quality of life by reducing the severity and/or frequency of symptoms and also the long-term prognosis. Patients with coronary artery disease have viable but dysfunctional myocardium. The metabolism of the ischemic myocardium is characterized by a shift from fatty acid to glucose as a preferred substrate and a decline in the levels of ATP. Targeting myocardial metabolism as a pharmacologic approach for chronic angina is based on the concept that metabolic adaptive mechanisms during ischemia resemble fetal energy metabolism by shifting substrate use towards glucose metabolism. Potential pharmacologic approaches should target i) the suppression of lipolysis and the plasma fatty acid levels and subsequent uptake and oxidation by the heart, ii) direct inhibition of the enzymes of fatty acid beta-oxidation, iii) inhibition of carnitine palmitoyl transferase- I (CPT-1). Currently, there are no approved medications directly targeting myocardial metabolism. However, in the last two years a number of medications indirectly targeting cardiac metabolism have been tested in small clinical trials, and some of them appear to be promising potential therapies for stable angina. This review summarizes the main aspects of myocardial metabolism and focuses on the therapeutic approaches that could offer clinical benefit in patients with stable angina.

Clinical implications of the BARI 2D and COURAGE trials: the evolving role of percutaneous coronary intervention

This review outlines the evolving role of percutaneous coronary intervention (PCI) for stable angina in the context of the widely discussed Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) and Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trials. Factors outlined include defining the appropriate patient population, the clinical circumstances, and the technical aspects of the procedure to optimize clinical outcomes and minimize risk. The COURAGE Trial, as others reported earlier, reported no difference in death or myocardial infarction with PCI compared with medical therapy for stable angina. In patients with type 2 diabetes mellitus in the BARI 2D Trial, a strategy of revascularization with coronary artery bypass graft surgery (CABG) or PCI resulted in no difference in mortality compared with optimal medical therapy. However, PCI for stable angina was associated with reduced angina and improved quality of life. Procedural aspects of PCI that support its continuing role in the management of patients with stable angina include the frequent advancements in PCI technology that have further enhanced both acute and long-term success. In conclusion, the implications of these findings for clinical practice include evaluating the use of PCI for stable angina in addition to optimal medical therapy to reduce angina and improve quality of life, but individualizing care for higher risk patients with more complex coronary artery disease who were not enrolled in the COURAGE and BARI 2D trials.

Interpreting the COURAGE trial. PCI is no better than medical therapy for stable angina? Seeing is not believing.

Interpreting the COURAGE trial. PCI is no better than medical therapy for stable angina? Seeing is not believing.

Coronary artery perforation complicated by cardiac rupture during conventional PCI

A 65-year-old female hypertensive, hypercholesterolaemic patient on medical therapy for stable angina presented with worsening symptoms. Coronary angiogram revealed a left coronary artery (LCA) with a 50% stenosis and a right coronary artery (RCA) subocclusion (Panel A). The patient underwent RCA angioplasty. The RCA subocclusion was crossed with guide wire, and multiple dilatations were performed using 2.0/18 and 2.5/20 mm balloons (Maverick, Boston Scientific). Two driver stents (24/3.5 and 30/4.0 mm, …

A review of stroke in patients with hypertension and coronary artery disease: focus on calcium channel blockers

Stroke is a major cause of morbidity and mortality worldwide. Hypertension is one of the most important risk factors for stroke - increasing the risk significantly. The presence and severity of coronary artery disease (CAD), which often coexists with hypertension, also predicts an increased risk of stroke. Lowering blood pressure (BP) to target in patients with hypertension can significantly reduce the incidence of fatal and non-fatal stroke. Effective BP control is even more important in CAD patients who are at greater risk of stroke. Data regarding the effects of antihypertensive therapy on stroke in patients with angina or CAD are limited and have been variable. To date, BP management strategies in patients with CAD have relied on small subsets of data based on high-risk hypertensive patients. Results with calcium channel blockers (CCBs) have been more positive than those with other classes of antihypertensive agents. Findings from the ACTION trial have provided a significant insight into the benefits of CCBs in patients with CAD and hypertension. Nifedipine gastrointestinal therapeutic system (GITS), in addition to best practice therapy for stable angina pectoris, contributes to a significant reduction in the risk of stroke in patients with CAD and hypertension who are at high risk and require effective BP control. Moreover, the incidence of stroke is significantly related to baseline BP, which may be an important factor to consider when deciding on treatment strategies in high-risk patients with CAD.

Gender Differences in the Management and Clinical Outcome of Stable Angina

We sought to examine the impact of gender on the investigation and subsequent management of stable angina and to assess gender differences in clinical outcome at 1 year. The Euro Heart Survey of Stable Angina enrolled patients with a clinical diagnosis of stable angina on initial assessment by a cardiologist. Baseline clinical details and cardiac investigations planned or performed within a 4-week period of the assessment were recorded, and follow-up data were collected at 1 year. A total of 3779 patients were included in the survey; 42% were female. Women were less likely to undergo an exercise ECG (odds ratio, 0.81; 95% CI, 0.69 to 0.95) and less likely to be referred for coronary angiography (odds ratio, 0.59; 95% CI, 0.48 to 0.72). Antiplatelet and statin therapies were used significantly less in women than in men, both at initial assessment and at 1 year, even in those in whom coronary disease had been confirmed. Women with confirmed coronary disease were less likely to be revascularized than their male counterparts and were twice as likely to suffer death or nonfatal myocardial infarction during the 1-year follow-up period (hazard ratio, 2.09; 95% CI, 1.13 to 3.85), even after multivariable adjustment for age, abnormal ventricular function, severity of coronary disease, and diabetes. Significant gender bias has been identified in the use of investigations and evidence-based medical therapy in stable angina. Women were also less likely to be revascularized. The observed bias is of particular concern in light of the adverse prognosis observed among women with stable angina and confirmed coronary disease.

Nitrate tolerance: a unifying hypothesis.

) production, endo-thelial dysfunction, and the neurohormonal activation that followlong-term administration of organic nitrates. In this issue ofCirculation, we will try to integrate these observations withother separate, and, to a certain extent, antagonistic hypothesesthat have been proposed for the development of nitrate toler-ance.

Potassium channel openers in myocardial ischaemia: therapeutic potential of nicorandil.

Potassium channel openers or agonists represent a novel new class of compounds in the treatment of a range of cardiovascular disorders, particularly angina pectoris and hypertension. Nicorandil is the only clinically available potassium channel opener with antianginal effects, and with comparable efficacy and tolerability to existing antianginal therapy. It confers benefits through a dual action: opening the mitochondrial KATP channels leading to preconditioning of the myocardium and a nitrate-like effect. Myocardial preconditioning is important in reducing infarct size, severity of stunning and cardiac arrhythmias. These effects make nicorandil a unique antianginal compound that reduces both pre- and after-load and improves coronary blood flow. Comparative and noncomparative studies support the use of nicorandil as monotherapy or in combination with other antianginal therapy for stable angina pectoris. However, large studies are required to confirm its role in the treatment of acute coronary syndromes despite the favourable results from small studies.

Silent ischemic interval on exercise test is a predictor of response to drug therapy: A randomized crossover trial of metoprolol versus diltiazem in stable angina

There is no method available to predict the relative antianginal efficacy of beta blockers and calcium-channel antagonists. The present study was undertaken to assess the role of silent ischemic interval (SII) on exercise treadmill test (ETT) as a predictor of response to therapy with metoprolol and diltiazem in patients with stable angina. Thirty-four patients with stable angina were divided into two groups depending upon the presence or absence of an SII gap of at least 1 min between onset of ST depression and appearance of angina on ETT. Metoprolol (50-100 mg twice daily) and diltiazem (60-120 mg three times daily) were randomly assigned for 6 weeks to patients in each group, and then patients were crossed over for further 6 weeks after a washout period of 2 weeks. Antianginal efficacy was assessed by clinical and exercise parameters. In patients with SII, the clinical responder rate was better with metoprolol than with diltiazem (90 vs. 60%, respectively), and on ETT, metoprolol produced significant improvement in the total exercise time (p< 0.01), time to 1 mm ST depression (p <0.01), time to angina (p <0.01), and a significant decrease in peak rate-pressure product (p<0.001), whereas diltiazem had no significant effect on exercise parameters. However, in patients without SII, metoprolol and diltiazem had a similar clinical responder rate (57%), and both produced a significant increase in total exercise time (p < 0.01), time to 1 mm ST depression (p < 0.01), and time to angina (p < 0.01). In addition, metoprolol had a significant effect on peak rate-pressure product (p < 0.001). Silent ischemic interval on ETT can be a predictor of response to antianginal therapy in stable angina, as patients with SII respond better to metoprolol and those without SII respond equally to both metoprolol and diltiazem.

Abciximab (Reopro): a clinically effective glycoprotein IIb/IIIa receptor blocker

Acute coronary syndromes are responsible for the deaths of tens of thousands of patients every year. Rupture of coronary atheromatous plaques with resultant luminal thrombosis is the cause in most cases. Although great steps forward have been taken in the management of acute myocardial infarction (MI) and unstable angina (UA), new therapeutic strategies are required to reduce further the incidence and risk of these events. At present, aspirin, nitrates and heparin are the conventional treatments for unstable angina. Aspirin, in combination with a thrombolytic agent or with percutaneous transluminal coronary angioplasty (PTCA), has been shown to be effective in reducing mortality in acute MI. Heparin is conventionally used in all PTCA procedures, whereas its efficacy in enhancing the therapeutic role of thrombolytic agents remains uncertain and may depend on the thrombolytic agent used. PTCA, which is also an effective therapy for stable angina, can be complicated by intimal dissection and thrombosis in a minority of cases, with vessel restenosis leading to recurrent symptoms in approximately 30% of cases. A number of new agents are being evaluated in both acute coronary syndromes and PTCA. These can be classified as adenosine diphosphate (ADP) receptor antagonists, Factor Xa inhibitors (low-molecular weight heparin [LMWH], direct thrombin inhibitors, new thrombolytic agents and glycoprotein IIb/IIIa receptor blockers. Of the latter, the most studied is abciximab, the Fab fragment of the chimeric monoclonal antibody, 7E3. This is a potent inhibitor of platelet aggregation. Four major clinical studies of PTCA in high-risk patients have demonstrated clear efficacy of abciximab in reducing acute ischaemic complications, mainly by reducing the frequency of MI and the need for repeat revascularisation. Unlike other glycoprotein IIb/IIIa receptor blockers, both short- and long-term efficacy have been demonstrated. Its impact on the rate of restenosis after PTCA is unclear. Abciximab’s role in an era of intracoronary stent implantation is undergoing further study (with encouraging early results). Its role in other situations, such as the early (non-angioplasty) management of unstable angina and its ability to enhance the efficacy of thrombolytic agents, is under active investigation.

Selection of drug therapy in stable angina pectoris.

Drug therapy in stable angina has two aims: the prevention of major cardiac events (such as unstable angina, myocardial infarction, or death) and the control of chest pain and transient myocardial ischemia. Given the low incidence of major cardiac events in patients with stable angina, primary preventive studies are scarce because they require a large sample size and long-term follow-up. Thus far, only aspirin and some lipid-lowering agents have been shown to be effective for this purpose. Antiischemic drugs reduce the imbalance between myocardial oxygen demand and supply, either by reducing oxygen consumption or by increasing coronary blood flow. The ideal approach would be to target drug therapy against the ischemia-inducing factor in each patient. The characteristics of anginal symptoms do not seem to help in selecting medical therapy, whereas a standard exercise test and a provocative test of coronary vasoconstriction may provide useful information in order to select patients who will preferentially respond to either a beta-blocker or a calcium antagonist. The combination of two or more anti-ischemic drugs does not seem to be any more effective than an adequately titrated monotherapy in reducing the occurrence of myocardial ischemia in individual patients. Combination therapy in stable coronary artery disease should include an individually selected and optimally titrated anti-ischemic agent and aspirin, with the addition of a lipid-lowering agent in patients with even mild hypercholesterolemia.

Percutaneous Transluminal Coronary Angioplasty Versus Medical Therapy for Stable Angina Pectoris: Outcomes for Patients With Double-Vessel Versus Single-Vessel Coronary Artery Disease in a Veterans Affairs Cooperative Randomized Trial

Objectives. This study sought to assess outcomes of men with double-vessel coronary artery disease randomly assigned to treatment by percutaneous transluminal coronary angioplasty (PTCA) or medical therapy, compared with previously reported outcomes for men with single-vessel disease.Background. We previously reported that PTCA provides better symptom relief and treadmill performance than medical therapy for men with stable angina pectoris due to single-vessel disease. Whether this advantage applies to patients with double-vessel disease is unknown.Methods. Male patients (n = 328) with stable angina pectoris and ischemia on treadmill testing were randomly assigned to PTCA or medical therapy; 101 patients had double-vessel disease, and 227 had single-vessel disease. Symptoms, treadmill performance, quality of life score, coronary stenosis and myocardial perfusion were compared at baseline and at 6 months. Patients were followed up for up to 6 years and underwent additional treadmill testing 2 to 3 years after randomization.Results. PTCA-treated and medically treated patients with double-vessel disease experienced comparable improvement in exercise duration (+1.2 vs. +1.3 min, respectively, p = 0.89), freedom from angina (53% and 36%, respectively, p = 0.09) and improvement of overall quality of life score (+1.3 vs. +4.4, respectively, p = 0.32) at 6 months compared with baseline. This contrasts with greater advantages favoring PTCA by these criteria in patients with single-vessel disease (p = 0.0001 to 0.02). Trends present at 6 months persisted at late follow-up. Patients undergoing double-vessel dilation had less complete initial revascularization (45% vs. 83%) and greater average stenosis of worst lesions at 6 months (74% vs. 56%). Likewise, patients with double-vessel disease showed less improved myocardial perfusion imaging (59% vs. 75%).Conclusions. PTCA is beneficial in male patients with double-vessel disease; however, we cannot demonstrate the same advantage over medical therapy seen in similar patients with single-vessel disease. Less complete revascularization and greater restenosis for patients having multiple dilations would account for these findings. Alternatively, a type 2 error might be operative. Technical advances since completion of this trial might improve these outcomes. These findings warrant further investigation in a larger trial.(J Am Coll Cardiol 1997;29:1505–11)