Angina pectoris in older persons

Antianginal therapy with a beta-blocker, a calcium channel blocker (CCB), or long-acting nitrates is recommended for angina relief in patients with chronic coronary disease (CCD). In patients with CCD who remain symptomatic despite treatment with a beta-blocker, CCB, and long-acting nitrates, ranolazine is recommended. In patients with CCD, sublingual nitroglycerin or nitroglycerin spray is recommended for immediate short-term relief of angina. For patients with lifestyle-limiting angina despite guideline-directed medical treatment (GDMT) with significant coronary stenoses amenable to revascularization, revascularization is recommended to improve symptoms. In patients with CCD who have significant left main disease or multivessel disease with a left ventricular ejection fraction of ≤35%, coronary artery bypass grafting (CABG) in addition to medical therapy is recommended over medical therapy alone to improve survival. High-risk unstable angina patients should be treated with early coronary revascularization rather than with an early conservative strategy. Other treatments for angina pectoris, including other antianginal drugs, cell therapy, transmyocardial laser revascularization, enhanced external counterpulsation, spinal cord stimulation, and the use of a coronary sinus reducer stent, are discussed.