A meta-analysis update: percutaneous coronary interventions

Area of Science:

• Cardiology
• Interventional Cardiology
• Evidence Synthesis

Background:

• Stable coronary artery disease (CAD) management involves balancing revascularization with medical therapy (MT).
• Previous meta-analyses have evaluated percutaneous coronary interventions (PCIs) versus MT, with evolving evidence.
• The optimal treatment strategy for stable CAD remains a focus of clinical research.

Purpose of the Study:

• To update the comparative effectiveness of PCIs versus MT in stable CAD.
• To incorporate data from two recent large randomized controlled trials (RCTs).
• To reassess the risks and benefits of PCIs in stable CAD.

Main Methods:

• Updated meta-analysis of eleven previously included RCTs and two new RCTs.
• Application of fixed-effects and random-effects models for summary estimates.
• Assessment of statistical heterogeneity and bias, including cumulative and influence analyses.

Main Results:

• No significant difference in mortality risk between PCIs and MT alone.
• PCIs associated with a 12% increased risk of cardiac death or myocardial infarction (MI).
• PCIs associated with a 22% increased risk of nonfatal MI; cumulative analysis favors MT.

Conclusions:

• Recent RCTs reinforce that PCIs offer no marginal benefit over MT for mortality in stable CAD.
• Evidence suggests PCIs increase the risk of cardiac death/MI and nonfatal MI compared to MT.
• Conclusions regarding PCI for preventing subsequent procedures remain uncertain due to study heterogeneity.