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4.3.5. Immunizations
COR LOE
Recommendations
1 A 1. In patients with CCD, an annual influenza vaccination
is recommended to reduce cardiovascular morbidity,
cardiovascular death, and all-cause death.
1 C-EO 2. In patients with CCD, coronavirus disease 2019
(COVID-19) vaccination is recommended per public health
guidelines to reduce COVID-19 complications.
2a B-NR 3. In patients with CCD, a pneumococcal vaccine is reasonable to
reduce cardiovascular morbidity and mortality and all-cause death.
4.3.6. Medical Therapy for Relief of Angina
COR LOE
Recommendations
1 B-R 1. In patients with CCD and angina, antianginal therapy with either
a beta blocker, CCB, or long-acting nitrate is recommended for
relief of angina or equivalent symptoms.*
1 B-R 2. In patients with CCD and angina who remain symptomatic after
initial treatment, addition of a second antianginal agent from a
different therapeutic class (beta blockers, CCB, long-acting nitrates)
is recommended for relief of angina or equivalent symptoms.*
1 B-R 3. In patients with CCD, ranolazine is recommended in patients
who remain symptomatic despite treatment with beta blockers,
CCB, or long-acting nitrate therapies.*
1 B-NR 4. In patients with CCD, sublingual nitroglycerin or nitroglycerin
spray is recommended for immediate short-term relief of angina
or equivalent symptoms.*
3: Harm B-R 5. In patients with CCD and normal LV function, the addition of
ivabradine to standard anti-anginal therapy is potentially harmful.*
* Modified from the 2012 ACC/AHA/Multisociety guideline for the diagnosis and
management of patients with SIHD. Fihn SD, et al. J Am Coll Cardiol. 2012;60:e44-e164.
4.3.7. Management of Refractory Angina
COR LOE
Recommendation
2b B-R 1. In patients with CCD, refractory angina, and no other
treatment options, enhanced external counterpulsation may
be considered for relief of symptoms.*
* Modified from the 2012 ACC/AHA/Multisociety guideline for the diagnosis and
management of patients with SIHD. Fihn SD, et al. op. cit.
4.3.8. Chelation Therapy
➤ EDTA is currently not approved by the FDA for preventing or treating
cardiovascular disease.
