Revascularization or Guideline-Directed Medical Therapy for Chronic Stable Angina? Evidence from a Prospective Cohort in a Resource-Limited Setting

Title : Revascularization or Guideline-Directed Medical Therapy for Chronic Stable Angina? Evidence from a Prospective Cohort in a Resource-Limited Setting

Abstract:

Background: The optimal management strategy for patients with chronic stable angina (CSA) remains under debate, especially in resource-limited settings. This study compared the efficacy and safety of percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) in patients with CSA and single-vessel coronary artery disease in Afghanistan.

Methods:
This prospective comparative study enrolled 211 patients with chronic stable angina and significant single-vessel coronary artery disease between 2015 and 2017. Participants received either PCI (n=105) or optimal medical therapy (n=106). Outcomes assessed at 12 

months included angina symptoms, exercise tolerance, quality of life, and major adverse cardiac events.

Results: At six months, the PCI group showed significantly greater improvement in total exercise duration (+126 vs. +30 seconds, p < 0.001) and a higher proportion of patients becoming angina-free (45.0% vs. 31.0%, p = 0.04) compared to the OMT group. The PCI group also experienced greater improvement in psychological well-being (QoL score improvement: +8.6 vs. +2.4 points, p = 0.03). The incidence of individual MACE components was significantly higher in the OMT group than in the PCI group. All-cause mortality was 7.5% (n=8) in the OMT group versus 0% (n=0) in the PCI group (p = 0.003), and myocardial infarction occurred in 14.2% (n=15) of the OMT group compared to 1.0% (n=1) of the PCI group (p < 0.001). Crossover from OMT to PCI due to refractory symptoms occurred in 10.4% (n=11) of patients.

Conclusion: In patients with chronic stable angina and single-vessel disease, PCI was superior to OMT in improving angina, exercise capacity, and quality of life at 12 months, and was associated with lower rates of mortality and myocardial infarction in this cohort. However, in low-income settings such as Afghanistan and other developing countries, where access to interventional cardiology is limited, guideline-directed medical therapy (GDMT) remains a valuable, safe, and essential alternative for the management of stable coronary artery disease.

Biography:

Abdul Wahed Sidiqi, MD, MSc, FESC, FAPSC, FJCS, is an Assistant Professor of Cardiology, President of the Afghanistan Cardiovascular Association, and Chairman of Ariana Medical Complex, Kabul. After completing cardiology training in the Netherlands in 2008, he played a leading role in establishing modern cardiology training in Afghanistan and has trained more than 100 physicians. Founded Afghanistan Cardiovascular Association in 2014, he earned a master’s degree in Invasive Cardiology in 2017, was elected a Fellow of the European Society of Cardiology (FESC) in 2023, fellow of the Asia pacific Society of cardiology (FAPSC) and Fellow of the Japan circulation Society (FJCS) in 2026.

Dr. Sidiqi has authored several scientific publications, including “Global Rounds Afghanistan: A Critical Overview of Cardiovascular Medicine,” published in Circulation, the journal of the American Heart Association. He has been a participant speaker at major international cardiology congresses, including the World Congress of Cardiology, Cardio Hub, EuroACHD in Madrid, and the Asia Pacific Society of Cardiology Congress in Taiwan. He received Best Presentation Awards at Cardio Hub and the EuroACHD Congress in Madrid in 2026.