Initial assessment involves a thorough history, including chest discomfort and related symptoms as well as risk factors, in order to assess the likelihood of coronary artery disease. This is followed by appropriate noninvasive testing guided by the probability of disease.
Management should focus on lifestyle modification, with emphasis on smoking cessation, weight management, physical activity, lipid control, and blood pressure control.
Antiplatelet therapy should be prescribed for all patients.
A stepwise addition of beta-blockers, calcium-channel antagonists, and/or long-acting nitrates should be provided to patients with chronic anginal symptoms.
Patients with persistent angina despite lifestyle modification and optimal medical therapy may warrant revascularization for reduction of symptoms.
Additionally, patients with high-risk coronary anatomy, as determined by noninvasive testing, may benefit from revascularization concurrent with initiation of lifestyle modification and medical therapy.