Stable Ischemic Heart Disease (SIHD)

Guideline-directed Medical Therapy

• Lipid Management
• BP control
  • Goal <140/90 ¹
• Diabetes control
• Smoking Cessation
• 🌟 Aspirin 💊
  • aspirin 75 to 162 mg daily should be continued indefinitely in the absence of contraindications in patients with SIHD ¹ (Class 1)
    • Can swap for clopidogrel if aspirin is contraindicated ¹
• 🌟 Beta-blockers 💊, namely carvedilol, metoprolol succinate, or bisoprolol
  • continue for at least 3 years in all patients with normal LV function after MI or ACS ¹
  • use in all patients with EF ≤40% or prior MI, unless contraindicated ¹
• 🌟 RAASi 💊
  • if pt has hypertension, diabetes, LVEF ≤40%, or CKD, unless contraindicated ¹
• Annual influenza vaccination
• Anti-Anginal Therapy 💊

Source: Figure 4 of ¹

Risk Stratification

Figure source: Figure 11 of ²

Cardiac Testing

Stable Chest Pain and No Known CAD

• Anatomic Testing
  • If intermediate-to-high risk, then CCTA is effective for diagnosis of CAD, for risk stratification, and for guiding treatment decisions (Class 1A) ²
• Stress Testing for intermediate-to-high risk patients
  • Stress imaging with stress echo, PET/SPECT MPI or CMR is effective for diagnosis of myocardial ischemia and for estimating risk of MACE (Class 1B) ²
    • PET is preferred over SPECT (Class 2a) to improve diagnostic accuracy and decrease the rate of nondiagnostic test results ²

Stable Chest Pain and Known CAD

Footnotes

1. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. Journal of the American College of Cardiology. 2012;60(24):e44-e164. doi:10.1016/j.jacc.2012.07.013 ↩ ↩² ↩³ ↩⁴ ↩⁵ ↩⁶ ↩⁷

2. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Journal of the American College of Cardiology. 2021;78(22):e187-e285. doi:10.1016/j.jacc.2021.07.053 ↩ ↩² ↩³ ↩⁴