Randomized comparison of percutaneous transluminal coronary angioplasty and medical therapy in stable survivors of
Uwe Zeymer1, Rainer Uebis, Albrecht Vogt
1Medizinische Klinik II, Klinikum Kassel, Berlin, Germany. Uwe.Zeymer@t-online.de
Circulation
|August 27, 2003
Summary
Percutaneous coronary intervention in stable heart attack survivors with single vessel disease may improve long-term outcomes and reduce nitrate use. Further research is needed before routine recommendation in this low-risk group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is frequently performed in stable survivors of acute myocardial infarction (AMI), even without symptoms or ischemia.
- Belief in improved clinical outcomes from PTCA persists despite a lack of randomized studies.
Purpose of the Study:
- To evaluate the efficacy of percutaneous revascularization versus medical therapy in stable patients post-AMI with single vessel disease.
- To assess long-term clinical outcomes, including reinfarction, need for reintervention, and angina.
Main Methods:
- A randomized trial involving 300 patients with single vessel disease 1-6 weeks after AMI.
- Patients were randomized to either angioplasty (n=149) or medical therapy (n=151).
- Primary endpoint was event-free survival at 1 year; long-term follow-up assessed survival and clinical events.
Main Results:
- Event-free survival at 1 year was higher in the angioplasty group (90%) compared to the medical group (82%) (P=0.06), driven by fewer reinterventions (8% vs. 20%, P=0.03).
- Long-term survival (mean 56 months) was significantly better in the angioplasty group (96% vs. 89%, P=0.02).
- Survival free of major adverse cardiac events was 80% in the angioplasty group versus 66% in the medical group (P=0.05), with significantly lower nitrate use in the angioplasty group.
Conclusions:
- Percutaneous revascularization of the infarct-related artery improves long-term clinical outcomes and reduces nitrate use in stable single-vessel disease patients post-MI.
- The findings suggest potential benefits of percutaneous coronary intervention in this low-risk subgroup.
- Larger, confirmatory studies are recommended before routine clinical practice adoption.
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