HNY Policy and Pathway Repository

Stable angina

This intervention is commissioned for patients with stable angina who:

• have ongoing anginal symptoms despite optimal anti- anginal medication OR
• have ongoing anginal symptoms with intolerance of anti-anginal medication OR
• are participating in clinical research in stable coronary artery disease.

This intervention is also commissioned, if agreed at an appropriately constituted myocardial revascularisation cardiac multidisciplinary meeting (MDM), for patients:

• with impaired ventricular systolic function OR
• with left main stem disease OR
• with significant ischaemic burden OR
• when otherwise considered appropriate by the MDM

This policy applies to patients 18 years and over.

This policy does not apply to patients:

• presenting with ST-elevation myocardial infarction, non ST-elevation myocardial infarction or staged procedures after acute coronary syndrome
• presenting with unstable angina defined as myocardial ischaemia at rest or on minimal exertion in the absence of acute cardiomyocyte injury/necrosis
• presenting with crescendo (rapidly worsening) stable angina
• who may be best treated with coronary artery bypass graft surgery 

The results of multiple trials in stable coronary artery disease (CAD), including COURAGE and ISCHEMIA have shown that revascularization does not improve mid-term mortality. However, revascularisation did significantly reduce spontaneous myocardial infarction in ISCHEMIA and around one third of the patients allocated to medical therapy in both COURAGE and ISCHEMIA had to undergo revascularisation within their primary follow up periods because of ongoing angina. There are selected subgroups where PCI can be offered at an earlier stage: patients with impaired left ventricular systolic function and significant left main stem disease. A multidisciplinary heart team approach and shared decision making with the patient are key.

Angioplasty for PCI (percutaneous coronary intervention) in stable angina - EBI

CG126 Stable angina: management | Guidance | NICE