Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a meta-analysis
Demosthenes G Katritsis1, John P A Ioannidis
1Department of Cardiology, Athens Euroclinic, Athens, Greece.
Insights
For stable coronary artery disease (CAD), percutaneous coronary intervention (PCI) does not reduce death or myocardial infarction compared to medical treatment. PCI offers no benefit unless patients have had a recent myocardial infarction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Stable coronary artery disease (CAD) management often involves percutaneous coronary intervention (PCI) or conservative medical treatment.
- Evidence on PCI's impact on mortality, myocardial infarction, and revascularization in stable CAD is limited.
- A meta-analysis was conducted to compare PCI with conservative treatment in stable CAD patients.
Purpose of the Study:
- To evaluate the effectiveness of PCI versus conservative medical treatment in patients with stable coronary artery disease (CAD).
- To assess the impact of PCI on mortality, myocardial infarction, and need for revascularization.
Main Methods:
- Meta-analysis of 11 randomized trials.
- Inclusion of 2950 patients (1476 PCI, 1474 conservative treatment).
- Analysis of outcomes including mortality, cardiac death, myocardial infarction, and revascularization procedures.
Main Results:
- No significant difference in mortality, cardiac death, myocardial infarction, or need for coronary artery bypass grafting (CABG) or PCI between PCI and conservative treatment.
- Risk ratios (95% CIs) for PCI vs. conservative treatment: mortality 0.94 (0.72-1.24), cardiac death/MI 1.17 (0.88-1.57), nonfatal MI 1.28 (0.94-1.75), CABG 1.03 (0.80-1.33), PCI 1.23 (0.80-1.90).
- A potential survival benefit for PCI was observed only in patients with a recent myocardial infarction (risk ratio 0.40, 95% CI 0.17-0.95).
Conclusions:
- Percutaneous coronary intervention (PCI) does not provide additional benefits over conservative medical treatment for patients with chronic stable coronary artery disease (CAD) without a recent myocardial infarction.
- PCI does not reduce the risk of death, myocardial infarction, or subsequent revascularization in this patient group.
- The findings suggest that conservative medical treatment is a viable option for stable CAD patients, reserving PCI for specific indications like recent myocardial infarction.
Background:
Percutaneous coronary intervention (PCI) has been shown to improve symptoms compared with conservative medical treatment in patients with stable coronary artery disease (CAD); however, there is limited evidence on the effect of PCI on the risk of death, myocardial infarction, and subsequent revascularization. Therefore, we performed a meta-analysis of 11 randomized trials comparing PCI to conservative treatment in patients with stable CAD.
Methods And Results:
A total of 2950 patients were included in the meta-analysis (1476 received PCI, and 1474 received conservative treatment). There was no significant difference between the 2 treatment strategies with regard to mortality, cardiac death or myocardial infarction, nonfatal myocardial infarction, CABG, or PCI during follow-up. By random effects, the risk ratios (95% CIs) for the PCI versus conservative treatment arms were 0.94 (0.72 to 1.24), 1.17 (0.88 to 1.57), 1.28 (0.94 to 1.75), 1.03 (0.80 to 1.33), and 1.23 (0.80 to 1.90) for these 5 outcomes, respectively. A possible survival benefit was seen for PCI only in trials of patients who had a relatively recent myocardial infarction (risk ratio 0.40, 95% CI 0.17 to 0.95). Except for PCI during follow-up, there was no significant between-study heterogeneity for any outcome.
Conclusions:
In patients with chronic stable CAD, in the absence of a recent myocardial infarction, PCI does not offer any benefit in terms of death, myocardial infarction, or the need for subsequent revascularization compared with conservative medical treatment.
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