Some patients with stable angina continue to experience persistent symptoms despite optimised guideline-directed medical treatment, including escalation to add-on agents. This protocol defines the structured next step when that add-on therapy does not achieve adequate symptom control.
What was tried: Add-on nicorandil or trimetazidine was initiated. In patients with left ventricular systolic dysfunction (LVEF <40%), add-on ivabradine was also used.
Goal not achieved: Adequate control and relief of angina symptoms was not attained with this regimen — meeting the threshold for escalation to this protocol.
Clinical goal: improvement and relief of angina symptoms.
In CCS patients with persistent angina or anginal equivalent, despite guideline-directed medical treatment, myocardial revascularization of functionally significant obstructive CAD is recommended to improve symptoms.
DOI: 10.1093/eurheartj/ehae177 View source ↗