Drugs in the PipelineRevascularization Versus Medical Treatments in Stable Coronary Artery Disease: Predicting the Future of Novel Drug Therapies for Stable AnginaRisos, Lamprini MD; Berkenboom, Guy MD, PhDAuthor Information Department of Cardiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. Reprints: Guy Berkenboom, MD, PhD, Service de Cardiologie, Hôpital Universitaire Erasme, Route de Lennik 808, Bruxelles 1070, Belgique (e-mail: firstname.lastname@example.org). Supported by the “Fonds pour la Chirurgie Cardiaque.” The authors report no conflicts of interest. Received July 04, 2013 Accepted November 14, 2013 Journal of Cardiovascular Pharmacology: March 2014 - Volume 63 - Issue 3 - p 213-217 doi: 10.1097/FJC.0000000000000051 Buy Metrics Abstract Abstract: Over the past 2 decades, drug therapy of patients with stable angina pectoris has improved, with a marked impact on the hard clinical outcomes of mortality and myocardial infarction. In contrast, recent trials have not demonstrated beneficial effects of revascularization on mortality. However, in the large trials that compared medical treatment with percutaneous coronary intervention (PCI) or surgery, high-risk patients, such as those with severe 3-vessel disease with or without left ventricular dysfunction, were excluded. In the COURAGE and FAME 2 trials, the only difference between the PCI and medical therapy groups was a higher rate of revascularization in the latter. Similar findings were made in studies comparing medical treatment with coronary surgery. New pharmacological approaches are being developed to further delay the progression of atherosclerosis. These include new lipid-lowering drugs acting in concert with statins (cholesteryl ester transfer protein inhibitors, proprotein convertase subtilisin/kexin type 9 inhibitors), aldosterone antagonists, colchicine, methotrexate, and interleukin-1 inhibitors. In conclusion, from the available data, PCI and coronary surgery have not been shown to improve hard end points and routine use of invasive revascularization should be avoided in patients with chronic stable angina. Evidence-based secondary prevention remains the most important approach. © 2014 by Lippincott Williams & Wilkins.