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Percutaneous coronary revascularization in coronary artery disease: lessons from a single center experience
Olcay Aksoy1, E Murat Tuzcu, Stephen G Ellis
1Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Insights
Percutaneous coronary intervention (PCI) improved survival in stable coronary artery disease (CAD) patients compared to medical management alone. This suggests PCI offers benefits beyond symptom relief in CAD patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- The benefit of percutaneous coronary intervention (PCI) in coronary artery disease (CAD) patients outside of acute settings remains unclear.
- Prior randomized controlled trials (RCTs) have focused on specific patient subgroups, necessitating further investigation into PCI's role in broader populations.
Purpose of the Study:
- To determine the role of PCI and its impact on all-cause mortality in patients with stable coronary artery disease (CAD).
- To compare the outcomes of PCI with medical management in a real-world patient cohort.
Main Methods:
- A retrospective analysis of 3,375 patients with stable CAD who underwent coronary angiography between 2004 and 2010.
- Patients were stratified by treatment (PCI vs. medical management) and analyzed using unadjusted and propensity-matched models.
- All-cause mortality was ascertained via the Social Security Death Index.
Main Results:
- PCI was associated with significantly better survival in both unadjusted (HR: 0.51; 95% CI, 0.41-0.63) and propensity-matched analyses (HR: 0.74; 95% CI, 0.55-0.98).
- The survival benefit of PCI persisted after excluding patients with malignancy or unstable angina.
- Mean patient age was 65 ± 11 years, 69% were male, and mean ejection fraction was 55% ± 8%.
Conclusions:
- This single-center registry analysis suggests that PCI may offer survival benefits in stable CAD patients compared to medical management alone.
- The findings indicate a potential role for PCI beyond symptom management in CAD.
- Further randomized trials are warranted to validate these findings in diverse patient populations.
Objectives:
To determine the role of percutaneous coronary intervention (PCI) and its impact on mortality in coronary artery disease (CAD).
Background:
It's unclear whether PCI provides benefit in patients with CAD outside of acute settings. We sought to determine the role of PCI and its effect on mortality in patients with similar entry criteria to prior RCTs and compare outcomes with medical treatment.
Methods:
Using institutional diagnostic catheterization database of consecutive patients undergoing coronary angiography from 1/2004 to 1/2010, we examined records for patients with a positive stress test and >70% coronary stenosis or symptoms of angina and >80% coronary stenosis. We excluded those with acute coronary syndromes, low ejection fraction (EF), history of CABG, and CABG following index catheterization. We stratified patients by treatment and performed unadjusted and propensity matched analyses. The outcome was all-cause mortality obtained from the social security death index.
Results:
We identified 3,375 patients using study inclusion criteria. Mean age was 65 ± 11 years and 69% (n = 2,332) were men. Mean EF was 55% ± 8%. In the unadjusted cohort, 1,265 patients received medical management and 2,110 received PCI. The unadjusted analysis revealed significantly better survival in PCI patients (P < 0.0001) (HR: 0.51; 95% confidence interval (CI), 0.41-0.63). Propensity matching was performed for 1,580 patients and analysis showed better survival among patients receiving PCI (0 = 0.04) (HR: 0.74; 95% CI, 0.55-0.98). PCI continued to show better survival after excluding patients with malignancy (P = 0.03) and unstable angina (P = 0.007).
Conclusions:
This single center registry analysis demonstrated better survival in stable CAD patients undergoing PCI compared to medical management alone. These data suggest there may be a benefit of PCI beyond symptom relief. Future randomized trials are needed to further understand the role of PCI in broader patient populations.
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