Individual research recommendation details

Recommendation ID

CG126/3

Question

Early revascularisation strategy for people with angina and multivessel disease:- In people with stable angina and multivessel disease (including left main stem disease) whose symptoms are controlled with optimal drug treatment, would an initial treatment strategy of revascularisation be clinically and cost effective compared with continued drug treatment?

Any explanatory notes
(if applicable)

Why this is important:- Research is needed to determine whether early investigation and revascularisation can improve longer term survival. People with stable angina may be disadvantaged if they do not have tests to identify whether they have a higher risk profile for early cardiac death, which could be reduced by revascularisation. This disadvantage could be magnified when people who are deemed to fall into very high risk groups (for example, left main stem stenosis > 50% in the MASS II trial) are excluded from randomised trials, resulting in the benefits of revascularisation being underestimated. We propose a randomised trial comparing an initial strategy of revascularisation (CABG or PCI) with an initial strategy of continued drug treatment in people with multivessel disease (including left main stem disease) in whom revascularisation is not needed for symptom relief. The trial should use drugeluting stents and wider inclusion criteria than BARI-2D and COURAGE.

Source guidance details

Comes from guidance

Stable angina: management

Number

CG126

Date issued

July 2011

Other details