This article is the second of two review articles on coronary artery disease. The focus is on treatment with coverage of medical treatment, intravascular interventions and surgical therapy. The review is aimed at a wide readership of physicians and other health care providers but also at students of various health sciences. Current literature is reviewed with special focus on recent Icelandic studies.

Table I.  Therapeutic agents used in the treatment of coronary artery diseae.   

Antianginal agents

            Nitrates

β-blockers

Calcium blockers

New agents (ivabradine, nicorandil, trimetazidine)

Agents used to reverse or slow progression of atherosclerosis

       Statins

Acetylsalicylic acid (aspirin)

Agents used to prevent or treat direct complications of atherosclerosis

       Antiplatelet agents

       Anticoagulants

Thrombolytics

 

Table II.  Complications following percutaneous coronary intervention.

 

Complications at the puncture site

Minor superficial bleeding

Major arterial bleeding

Retroperitoneal bleeding

Vessel spasm

Pseudoaneurysm

Infection

Shock – death

 

Coronary complications

Spasm

Thrombosis and embolism

Dissection – vessel closure

Closure of a side branch

Misplacement or loss of stent

Wire exit – pericardial bleeding, cardiac tamponade

Myocardial infarction

Stent infection

 

Cardiac arrhythmias

Ventricular extra systoles

Supraventricular extra systoles

Atrial fibrillation / flutter

Ventricular fibrillation / flutter

Bradycardia – vasovagal reactions

Cardiac arrest

 

Chest pain (ischemia, pericarditis, other causes)

Drug- or contrast allergy

Renal impairment/failure

Stroke

Restenosis at interventional site (< 3 months)

 

Table III. The most common early complications found in a survey of 720 consecutive patients undergoing coronary revascularization at Landspitali University Hospital between 2002 and 2006.

Variable	n = 720, %	p-value
Major complications	118 16)	0.44
Stroke	16 (2)	0.79
Deep sternal wound infection	6 (0.8)	0.84
Renal injury requiring dialysis	12 (2)	0.97
Perioperative myocardial infarction	95 (13)	0.35
Multi organ failure	23 (3)	0.60
Sternal insufficience	19 (3)	0.31
Minor complications	391 (54)	0.05
Atrial fibrillation/flutter	294 (41)	0.50
Superficial wound infection	65 (9)	0.53
Pneumonia	45 (6)	0.41
Urinary tract infection	27 (4)	0.11

Figure 1. Stabilization of an unstable atherosclerotic coronary artery plaque with lipid lowering statins. Picture: Guðbjartur Kristófersson.

Figure 2. Coronary angiography showing significant stenosis in the left coronary atery (a) that was dilated and coronary stent implanted (arrow). Picture: Ragnar Danielsen.

Figure 3. Percutaneous coronary intervention with placement of coronary stent.

Figure 4. Schematic drawing of coronary artery bypass grafting (CABG) procedure. The left internal mammary artery (LIMA) has been grafted to the left anterior descending artery (LAD) and two separate greater saphaneous vein grafts have been anastomosed to additional coronary targets. Picture: Hannes Sigurjónsson.

Figure 5 (a). CABG at Landspitali. The heart- and lungmachine is seen in front. Picture: Ragnar Th. Sigurðsson. (b). Specially designed instruments for performing coronary bypass surgery on a beeting heart (off-pump). With courtesy of Medtronic Inc.

Figure 6a-c. Harvest of left internal mammary artery (a), and great saphenous vein (b), and a deep sternal wound infection following CABG. Pictures: Tómas Guðbjartsson.

Figure 7. Overall and disease-specific survival of patients that underwent CABG in Iceland between 2002 and 2006 (Kaplan-Meier). Broken lines indicate 95% confidence interval.