Papers p 73

Angina pectoris is a common manifestation of coronary artery disease. Effective treatment was not available until Brunton introduced nitrate of amyl in 1867.1 Drugs for the treatment of chronic angina became available much later, first the long acting nitrates, β blockers in the 1960s, and calcium antagonists in the 1970s. At the same time, bypass surgery and, later, percutaneous transluminal coronary angioplasty were introduced.

In this issue of the BMJ Bucher and colleagues report a meta-analysis of randomised controlled trials comparing percutaneous transluminal coronary angioplasty and medical treatment for non-acute coronary artery disease (p 73).2 The treatment of stable angina aims to reduce chest pain and prevent cardiovascular events. 1 3 Bypass surgery is more effective than medical treatment, at least according to trials carried out in the 1970s, but it is expensive, is associated with morbidity and mortality, and needs patients to stay longer in hospital.3 Percutaneous transluminal coronary angioplasty can be performed immediately after a diagnostic procedure and is less invasive than surgery, and patients can leave the hospital next day.4 However, it has periprocedural complications, and restenosis limits its benefits in certain patients.

Of the drug treatments, there is evidence that only β blockers reduce …