Stable coronary artery disease: latest data in the battle between conservative and invasive management.

M yocardial revascularisation has been an established mainstay therapy for coronary artery disease (CAD) since the late 1960s. Rene Favoloro introduced CABG into clinical practice in 1967 and since then it has been the most intensively studied surgical procedure. Percutaneous revascularisation techniques have been in use for 35 years and have been subjected to more randomised studies (RCTs) than any other interventional procedure. Balloon angioplasty (PTCA) was used for the first time in 1977, by Andreas Gruentzig of Germany, as a non-surgical method for coronary artery revascularisation and in the mid 1980s it was proposed as an alternative therapy to coronary artery bypass grafting (CABG). Both reperfusion methods entail procedural risks that differ with respect to their nature, incidence, and time distribution. While both procedures have seen significant technological advances, their role in the management of patients with stable CAD has been called into question by progress in medical treatment, also known as optimal medical therapy (OMT), which includes radical modification of cardiovascular risk factors and lifestyle in combination with intensive pharmacological management. These important developments in all three therapeutic strategies have relegated the findings of older studies to being of solely historical interest.