Coronary artery disease is still highly prevalent worldwide, and stable angina pectoris is one of its more common presentations. Stable angina is a clinical expression of myocardial ischaemia associated with fixed atherosclerotic coronary stenosis, which prevents the adaptation of coronary perfusion to an increased oxygen requirement. The goals of treatment include relief of symptoms, inhibition or slowing of disease progression, prevention of future cardiac events such as myocardial infarction (MI), and improved survival. This article reviews the treatment modalities currently available to alleviate the symptoms of chronic angina and to reduce the risk of future MI and cardiac death, including several novel pharmacological treatments, coronary revascularisation, as well as novel technologies that may benefit selected groups of patients who are refractory to both drugs and revascularisation (fig 1⇓).

ANTIANGINAL AND ANTI-ISCHAEMIC DRUGS

Three major classes of anti-ischaemia drugs are currently used in the medical management of angina pectoris: β-blockers, nitrates (short- and long-acting), and calcium channel antagonists (table 1⇓). All three have been shown to prolong the duration of exercise before the onset of angina and ST segment depression as well as to decrease the frequency of angina. However, none prevents MI or death caused by coronary disease in patients being treated specifically for chronic stable angina.

Although the clinical guidelines of the American College of Cardiology/American Heart Association (2002) and the European Society of Cardiology (2006) suggest that β-blockers be used as the first-line agents in patients with stable angina,^1–,³ head-to-head comparative trials failed to demonstrate a greater antianginal efficacy for …