The treatment of coronary artery disease (CAD) encompasses many strategies all of which aim to improve symptoms and prognosis. While in the acute coronary syndrome, early revascularisation (usually by means of PCI and stent implantation) is the urgent goal of treatment, drug therapy initially has only a supportive role here but is also important for improving prognosis. The situation is reversed in the case of the treatment of chronic stable CAD: here conservative drug therapy has the dominant role and if implemented optimally is so successful that the prognosis cannot be further improved with additional PCI and stent implantation. Therefore, the indication for revascularisation should not only be based on an angiographic but also on a functional (FFR, fractional flow reserve) assessment of the stenosis.This book is therefore a critical presentation of the benefit of treatment strategies in the different forms of CAD. In addition to the value of lifestyle changes, it deals with the evaluation of the various drug therapies, invasive procedures such as PCI and stent implantation, bypass surgery and electrotherapeutic measures with ICD, CRT and cardiac pacemakers. The authors have succeeded in producing a textbook that is not just of interest to the attending doctor but also for patients affected by the disease. A textbook from the viewpoint: what is optimal? What is economic? What is evidence-based?

1.From Primary to Secondary Prevention301.1.Definition301.2.Risk factors for atherosclerosis301.3.Aims of secondary prevention321.4.Primary vs secondary prevention321.5.Risk stratification331.6.Blood pressure/HbA1c goals361.7.HbA1c target in diabetics381.8.Lipids381.9.Non-pharmacological therapeutic measures401.10.Lifestyle and mortality risk401.11.Who has the highest cardiovascular risk?411.12.NSAIDs and cardiovascular risk421.13.Vitamin D and atherosclerosis421.14.Exposure to ambient air pollution and noise421.15.MI risk with testosterone and PDE 5 inhibitors431.16.Cardiovascular risk and events in low, middle and high income countries431.17.Summary431.18.References432.Manifestations and Prognosis of CAD472.1.Manifestations of atherosclerosis472.2.Manifestations of CAD472.3.Prognosis of CAD492.4.Prognosis and gender512.5.Prognosis in renal insufficiency512.6.Prognosis and diabetes522.7.Prognosis and type of medical care532.8.Prognosis for myocardial infarction532.9.An obesity paradox in ACS?542.10.Decrease in CAD mortality?542.11.Prognosis with guideline-oriented therapy?562.12.National differences in prognosis for AMI562.13.Refractory a.p. Prognosis?562.14.A.p. without CHD?572.15.Cardiac syndrome X572.16.Prognosis in ACS and AV III or Mobitz II572.17.Radial vs femoral access in ACS The MATRIX study572.18.Summary582.19.References583.From the Endothelial Defect to Myocardial Infarction613.1.The importance of the endothelium613.2.The acetylcholine test as a method to demonstrate endothelial dysfunction623.3.Clinical impact of endothelial dysfunction during stress623.4.Endothelial dysfunction as a prognostic indicator633.5.Endothelial progenitor cells633.6.Atherosclerosis in the coronary region643.7.From atherothrombosis to the acute syndrome663.8.Histomorphology of vulnerable plaques673.9.Remodelling of the left ventricle after myocardial infarction673.10.Collateral formation in atherosclerosis683.11.The natural course of atherosclerosis693.12.Summary693.13.References704.Pathophysiology of CAD and Strategies for Secondary Prevention724.1.Coronary insufficiency724.2.Determinants of the myocardial O2 requirement734.3.Heart rate734.4.Antianginal agents and their points of attack744.5.Strategies for secondary prevention754.6.Therapeutic priorities depending on the form of presentation of CAD764.7.Stem cell therapy774.8.Myocardial infarction due to embolism774.9.Summary774.10.References785.Nitrates and Other Antianginal Agents805.1.Mechanism of action of nitrates805.2.Nitrate drugs805.3.Do nitrates prolong survival in CAD?815.4.Nitrates in secondary prevention825.5.Molsidomine825.6.Trapidil835.7.Nicorandil, a potassium channel opener 835.8.Ranolazine845.9.Trimetazidine855.10.Guidelines for anti-anginal drugs855.11.Summary865.12.References866.Beta-Blockers896.1.Mechanism of action of beta-blockers896.2.Classification of beta-blockers896.3.Differences between beta-blockers896.4.Treatment aims on beta-blockers906.5.Beta-blockers in post-infarct patients906.6.Who benefits most?916.7.Do all beta-blockers have a secondary prevention effect?936.8.Can beta-blockers be used for secondary prevention in CAD without infarction?936.9.Beta-blockers in heart failure956.10.Third-generation beta-blockers956.11.Beta-blockers in LV dysfunction after infarction The CAPRICORN study956.12.Guidelines976.13.Summary986.14.References997.Calcium antagonists1027.1.Mechanism of action of calcium antagonists1027.2.Differences between the calcium antagonists1027.3.Calcium antagonists in stable angina1027.4.Dihydropyridines in postinfarct patients1037.5.Diltiazem in postinfarct patients1037.6.Verapamil in postinfarct patients1047.7.Hypertensive vs normotensive postinfarct patients1057.8.Third-generation calcium antagonists in CAD1057.9.AHA/ACCF and ESC guidelines1077.10.Summary1087.11.References1088.ACE Inhibitors1108.1.Mechanism of action1108.2.Pathophysiological basis of ACE inhibitor treatment1108.3.ACE inhibitors and aspirin1128.4.Postinfarction studies with ACE inhibitors1138.5.ACE inhibitors and risk of AF1168.6.The HOPE study1168.7.ACE inhibitors and rate of infarction1188.8.ACE inhibitors in association with and after PTCA The QUIET study1188.9.ACE inhibitors in CAD patients with a lower risk1198.10.AHA/ACCF and ESC guidelines1218.11.Summary1228.12.References1229.AT1 Receptor Blockers1259.1.The mechanism of action1259.2.AT1 receptor blockers and pleiotropic effects1259.3.Clinical studies in CAD1269.4.Combination of ACE inhibitor plus AT1 receptor blocker1299.5.ACCF/AHA and ESC guidelines1299.6.Summary1309.7.References13010.Statins and Non-Statins (Ezetimibe, PCSK9 Inhibitors)13210.1.Situation before the statin era13210.2.Mechanism of action of the statins13210.3.A comparison of statins13210.4.Statins and dose-effect relationship13310.5.Statins in secondary prevention The evidence from studies13410.6.The time for using a statin during and after acute coronary syndrome13810.7.Statins and number of revascularisations13910.8.Statins after CABG and PTCA13910.9.Statins in PTCA14010.10.Statins before PCI?14110.11.Who benefits from LDL lowering? Younger or older patients?14210.12.Additional effects of statins14210.13.The greater the LDL reduction, the better14510.14.Statins in high-risk patients15010.15.Two maximum statin doses The SATURN trial15110.16.Statins and diabetes risk15210.17.Non-statins15210.18.LDL treatment targets today The guidelines15510.19.Summary15910.20.References16011.Antiplatelet Agents16511.1.Antiplatelet agents An overview16511.2.Mechanism of action of antiplatelet agents16511.3.Molecular target of the thienopyridines16611.4.Prasugrel vs clopidogrel16611.5.Ticagrelor and cangrelor16711.6.Clopidogrel vs prasugrel vs ticagrelor16711.7.Glycoprotein IIb/IIIa receptor inhibitors16811.8.Aspirin (acetylsalicylic acid)16811.9.Aspirin plus low-dose coumarins17011.10.Clopidogrel vs aspirin17111.11.Clopidogrel plus aspirin17211.12.Clopidogrel and interaction with PPIs17711.13.Rebound phenomena and resistance17811.14.Measurement of platelet reactivity A treatment advisor?17911.15.Vorapaxar The PAR-1 receptor antagonist18011.16.Ticagrelor in secondary prevention The PEGASUS-TIMI 54 study18111.17.Duration of DAPT?18211.18.Current guidelines18211.19.Summary18411.20.References18512.Anticoagulants19012.1.The Sixty Plus study in the elderly19012.2.The WARIS-1 study19012.3.The ASPECT-1 study19012.4.The ASPECT-2 study19112.5.The WARIS-2 study19112.6.The APRICOT-2 study19112.7.Indications for coumarins today19112.8.Antithrombotic treatment in AF19212.9.A new era for anticoagulation in AF19412.10.Apixaban vs aspirin in AF The AVERROES study19912.11.Dabigatran in mechanical heart valves The RE-ALIGN study20012.12.Duration of triple therapy?20012.13.VKA plus aggregation inhibitors in stable CAD and AF?20112.14.Bridging in AF with LMWH Yes or no?20112.15.Current guidelines20212.16.Summary20312.17.References20413.Antihypertensive Agents20713.1.Hypertension and risk in CAD20713.2.The HOPE study20713.3.Isolated systolic hypertension (ISH)20813.4.The INVEST study20813.5.The VALUE study20913.6.The EUROPA study20913.7.Which combination therapy The ACCOMPLISH study21013.8.Blood pressure after ACS21213.9.Effects of sodium reduction21213.10.Target blood pressure values in CAD The guidelines21213.11.Summary21413.12.References21514.Omega-3 Fatty Acids21814.1.The GISSI Prevention study21814.2.The OMEGA study21914.3.Conclusion21914.4.Current guidelines21914.5.Summary22014.6.References22015.Ivabradine, the If Channel Blocker22115.1.Heart rate and risk in CAD22115.2.Ivabradine and effects on symptoms 22115.3.Ivabradine and effects on prognosis 22115.4.Indications for ivabradine (EMA 2015)22415.5.Current guidelines22515.6.Summary22515.7.References22616.UA/NSTEMI = NSTE-ACS22816.1.Definition22816.2.Diagnosis of ACS (UA/NSTEMI/STEMI)22816.3.The prognosis in UA/NSTEMI23016.4.Aims of treatment23116.5.Nitrates in UA/NSTEMI23116.6.Beta-blockers23116.7.Calcium antagonists23116.8.Aspirin23216.9.Heparin in unstable angina / NSTEMI23216.10.Pentasaccharides23316.11.Bivalirudin23316.12.GP IIb/IIIa inhibitors in UA/NSTEMI23416.13.Clopidogrel plus aspirin in UA/NSTEMI23616.14.Prasugrel vs clopidogrel23916.15.Ticagrelor in ACS24416.16.Statins in acute coronary syndrome24716.17.Invasive vs non-invasive approach in UA/NSTEMI24916.18.The importance of GP IIb/IIIa inhibitors in PCI25216.19.Improvement in prognosis in NSTE-ACS25316.20.Timings during treatment of NSTEMI-ACS25316.21.The GRACE risk score25416.22.Current UA/NSTEMI guidelines25516.23.Summary25716.24.References25917.The Treatment of Acute Myocardial Infarction (STEMI)26417.1.The effect of thrombolysis26417.2.Aspirin26717.3.Clopidogrel26817.4.Prasugrel vs clopidogrel in STEMI The TRITON-TIMI 38 study27017.5.Ticagrelor vs clopidogrel in STEMI patients The PLATO study27017.6.Anticoagulant agents27117.7.Nitrates27317.8.Beta-blockers27517.9.ACE inhibitors / AT1 receptor blockers / aldosterone-receptor blockers27617.10.Calcium antagonists27817.11.Antiarrhythmics (lidocaine prophylaxis)27817.12.PTCA in acute infarction (STEMI)27817.13.Lysis vs transport to a PCI centre27917.14.PTCA vs PTCA plus stent28017.15.PCI plus stent plus GP IIb/IIIa inhibitor28017.16.Aim in STEMI treatment: Primary PCI!28117.17.DES vs BMS in STEMI28217.18.National differences in the hospitalisation time28217.19.The prognosis in STEMI28217.20.The new classification of infarction28317.21.Dual antiplatelet therapy (DAPT) plus new oral anticoagulants (NOACs)?28317.22.Thrombus aspiration during STEMI 28517.23.Intra-aortic balloon pump (IABP) counterpulsation28517.24.Current STEMI guidelines28617.25.Preventative angioplasty in STEMI?28817.26.Summary28917.27.References29018.Revascularisation Procedures in Stable CAD29618.1.Bypass surgery29618.2.PTCA29818.3.Stents29918.4.PTCA/PCI vs CABG30318.5.PTCA vs atherectomy30618.6.Transmyocardial laser revascularisation30718.7.Beta-blockers before CABG30718.8.FFR measurement30718.9.CABG in CAD and LVEF £35% The STICH study30918.10.Adherence to guidelines for PCI and CABG31018.11.Measures in refractory angina31118.12.CABG vs minimally invasive surgery 31218.13.The current guidelines31318.14.Summary31518.15.References31619.Stable CAD: Conservative Therapy vs Interventional/Surgical Therapy32119.1.Current secondary prevention and targets in stable CAD32119.2.Additive effects with four secondary prevention agents?32219.3.Individual conservative measures in chronic stable CAD vs PCI32519.4.Optimised secondary prevention vs PCI with stent32619.5.Is late reperfusion worthwhile? The open artery hypothesis32819.6.Intensive medical therapy vs prompt revascularisation in diabetics with stable CAD32919.7.Meta-analyses on optimised secondary prevention vs PCI33019.8.FFR and OMT vs OMT The FAME II study33219.9.Routine vs quantitative coronary angiography33419.10.No successes with low risk33419.11.Conservative vs interventional/surgical therapy33619.12.The problem and a suggested solution33619.13.COURAGE and Wall Street A controversial subject33619.14.Prioritising before rationing34019.15.Guidelines for chronic stable CAD34019.16.Summary34119.17.References34220.Therapy in Postinfarction Failure34620.1.Pathophysiological background34620.2.Spironolactone in NYHA class III and IV34620.3.Eplerenone in NYHA II The EMPHASIS-HF study34620.4.Eplerenone after acute myocardial infarction with LV dysfunction34720.5.Eplerenone in acute STEMI without heart failure?34820.6.Stem cells in chronic ischaemic cardiomyopathy34920.7.Beta-blockers in heart failure and AF34920.8.The STITCH substudy on surgical ventricle reconstruction34920.9.A new strategy: Angiotensin receptor neprilysin inhibitor (ARNI)34920.10.Guidelines35120.11.Summary35320.12.References35421.Antiarrhythmic Drugs35621.1.Pathophysiological background35621.2.The pro-arrhythmogenic effect in relation to the ejection fraction35621.3.Clinical studies in ventricular extrasystoles35621.4.Amiodarone in heart failure35721.5.Amiodarone in post-infarct patients35721.6.Antiarrhythmics in AF35821.7.Does digoxin increase mortality in atrial fibrillation?36421.8.Vernakalant36521.9.Short-term vs long-term antiarrhythmic therapy after cardioversion for AF36521.10.Catheter ablation in AF36521.11.Current guidelines36521.12.Summary36621.13.References36722.ICD, CRT, Cardiac Pacemakers, Implantable AF Recorder, IABP37022.1.The implantable defibrillator (ICD)37022.2.Cardiac resynchronisation therapy (CRT)37722.3.Programmed stimulation for risk identification38322.4.Cardiac pacemaker therapy38422.5.Implantable cardiac recorder for AF detection38522.6.Intra-aortic balloon counterpulsation (IABP)38522.7.Summary38622.8.References38723.Lifestyle, Body Weight, Smoking, Alcohol, Physical Activity and Rehabilitation39123.1.Diet39123.2.Normalisation of body weight39323.3.Smoking39723.4.Alcohol40023.5.Physical activity and rehabilitation40323.6.When should lifestyle changes begin?40523.7.Sex hormones (oestrogens/testosterone) in prevention?40623.8.Multivitamins and minerals?40623.9.Dark chocolate40623.10.Guidelines on lifestyle40723.11.Summary40723.12.References40924.Abbreviations414Index418