Management of Asymptomatic Elderly Males with Stable Ischemic Heart Disease

Indications for Invasive Procedures

The American College of Cardiology recommends that coronary angiography is not performed to assess risk in asymptomatic patients with no evidence of ischemia on noninvasive testing 1
The European Society of Cardiology states that invasive coronary angiography is not recommended solely for risk stratification 2
The American Heart Association guidelines indicate that coronary angiography is not recommended for patients who are at low risk according to clinical criteria and who have not undergone noninvasive risk testing 1

The American College of Cardiology recommends aspirin 75-325 mg daily for all patients with chronic ischemic heart disease, unless contraindicated 3, 4
The American College of Cardiology suggests statin therapy to maintain LDL <70 mg/dL 5
The American College of Cardiology recommends ACE inhibitor for patients with coronary artery disease or other vascular disease 5
The American College of Cardiology recommends beta-blocker if there is history of prior myocardial infarction 5

The European Society of Cardiology emphasizes the importance of continued lifestyle modifications, including exercise, weight management, and cardiovascular risk factor control, for asymptomatic patients with stable ischemic heart disease 2, 3, 4

The American College of Cardiology recommends maintaining LDL below 70 mg/dL through lifestyle modifications and medical therapy to stabilize atherosclerotic plaque and reduce cardiovascular events 3, 4

The European Society of Cardiology states that angiography would only become reasonable if the patient develops new or worsening anginal symptoms despite optimal medical therapy 2, 1
The American College of Cardiology recommends considering angiography if the patient has high-risk features on noninvasive stress testing, symptoms or signs of heart failure, or has survived sudden cardiac death or life-threatening ventricular arrhythmia 1