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Nash convincingly demonstrates that for chronic stable coronary artery disease, invasive procedures afford no mortality benefit compared with medical treatment.¹ He credits Forrester and Shah² with having noted this fact in 1997, ignoring that already a quarter of a century earlier we had demonstrated exceptional survival with a paucity of hard cardiovascular end points for medically treated patients with coronary heart disease.^3-4 It needs to be recalled that at the time key pharmaceutical agents, especially statin drugs, were unavailable. Results were significantly improved in a recently reported larger study from our group involving 693 patients with coronary heart disease.⁵ The annual incidence of nonfatal myocardial infarction, cardiac mortality, and total mortality was 2.2%, 0.8%, and 1.4%, respectively, during an average follow-up of 4.6 years.

The slim justification for the enormous surfeit of costly invasive procedures now rests on the thin reed that angina pectoris is thereby improved. Over several decades . . . [Full Text of this Article]

AUTHOR INFORMATION
Thomas B. Graboys, MD; Bernard Lown, MD

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The Case for Medical Treatment in Chronic Stable Coronary Artery Disease
David T. Nash
Arch Intern Med. 2005;165(22):2587-2589.
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