Ischemic Heart Disease Treatment: Antiplatelet Agents, Coronary Stents, Bypass Surgery, and Secondary Prevention

Ischemic heart disease remains one of the leading causes of morbidity and mortality worldwide. Despite significant advances in its management, the need for a comprehensive approach that includes antiplatelet agents, coronary revascularization, and secondary prevention is crucial for improving long-term outcomes in affected patients.

Diving Deeper into Treatment

The use of antiplatelet agents is fundamental in the treatment of ischemic heart disease. Aspirin has long been the cornerstone of treatment, but P2Y12 receptor inhibitors such as clopidogrel, prasugrel, and ticagrelor have shown to improve outcomes in patients with acute coronary syndromes, especially when used in combination with aspirin in dual antiplatelet therapy [1]. However, the optimal duration of this therapy remains a topic of debate, and personalizing treatment according to the patient's risk profile is increasingly important [2].

Regarding coronary revascularization, both percutaneous coronary intervention (PCI) with coronary stents and coronary bypass are viable options. The choice between these techniques depends on multiple factors, including coronary anatomy and patient comorbidities. Recent studies have highlighted the importance of physiological assessment using fractional flow reserve (FFR) to guide the revascularization decision [3]. Additionally, the no-touch harvesting technique for saphenous vein grafts has shown to reduce the risk of graft failure in coronary bypass surgery [4].

Secondary prevention is an essential component of managing ischemic heart disease. The use of statins for lipid optimization, along with lifestyle modification, are key strategies to reduce the risk of future cardiovascular events. However, adherence to these long-term interventions remains a challenge, and regular follow-up by healthcare professionals has been shown to significantly improve adherence and optimization of risk factors [5].

Conclusions

The treatment of ischemic heart disease requires a multifaceted approach that combines the use of antiplatelet agents, appropriate revascularization strategies, and robust secondary prevention. Personalizing treatment according to the patient's risk profile and implementing follow-up programs are essential for improving long-term outcomes. Ongoing research and updates to clinical guidelines are fundamental to optimizing the management of this prevalent disease.

Referencias

• [1] Antiplatelet and antithrombotic treatment for secondary prevention in ischaemic heart disease.
• [2] Personalized Dual Antiplatelet Therapy in Acute Coronary Syndromes: Striking a Balance Between Bleeding and Thrombosis.
• [3] Impact of Antiplatelet Therapy on 5-Year Outcomes After Fractional Flow Reserve-Guided Deferral of Revascularization in Nonsignificant Obstructive Coronary Artery Disease.
• [4] Saphenous Vein Graft Failure: From Pathophysiology to Prevention and Treatment Strategies.
• [5] Optimal medical therapy, lifestyle intervention, and secondary prevention strategies for cardiovascular event reduction in ischemic heart disease.

Created 2/1/2025