Angina de pecho estable. Trascendencia clínica en la era de la intervención, limitaciones y avances actuales de su terapia farmacológica

Stable angina continues to be an important problem, even in the era of coronary revascularization. Its significance lies in its high prevalence (i.e., 2-4 % of the population) and its impact on health resources. Although the prognosis of stable angina is more favorable than that of acute coronary syndrome, angina leads to a deterioration in quality of life and to frequent problems with therapy. Annual mortality is some 0.5-2.6% and the incidence of nonfatal myocardial infarction is 1-2% a year. The aims of treatment in patients with stable angina are: 1) to improve prognosis by preventing myocardial infarction and death by reducing the incidence of acute thrombotic events and by countering the development of left ventricular dysfunction, and 2) to improve symptoms by reducing the number of ischemic episodes and improving quality of life. Antianginal treatment is frequently suboptimal because of a low level of adherence to treatment guidelines, which also results in frequent side effects. Interventions aimed at increasing guideline adherence and new drugs, such as ivabradine, can help improve treatment in patients with stable angina.