Percutaneous Coronary Intervention in Stable Coronary Heart Disease -Is Less More?

Area of Science:

• Cardiology
• Interventional Cardiology
• Public Health

Background:

• Stable angina pectoris and coronary heart disease (CHD), now chronic coronary syndrome (CCS), are prevalent conditions.
• The efficacy of percutaneous coronary intervention (PCI) compared to optimal medical therapy (OMT) remains a key area of research.
• Current PCI practices in Germany are scrutinized for their alignment with scientific evidence.

Purpose of the Study:

• To review the evidence for PCI versus OMT in patients with CCS.
• To assess whether current indications for PCI in Germany align with scientific knowledge.
• To evaluate the role of PCI in managing stable angina and asymptomatic CHD.

Main Methods:

• Review of pathophysiological concepts of CHD and ischemia.
• Analysis of seven randomized trials comparing PCI with OMT.
• Presentation of current PCI utilization data from Germany.

Main Results:

• Vulnerable plaques causing myocardial infarction are difficult to identify prospectively.
• PCI does not improve long-term survival or reduce myocardial infarction incidence compared to OMT in CCS patients.
• PCI based solely on stenosis morphology, without functional assessment, is often detrimental and contradicts guidelines.

Conclusions:

• PCI for CCS offers limited outcome improvement for most patients.
• Symptomatic benefit of PCI is primarily observed in patients with frequent angina pectoris.
• Stricter adherence to guidelines for CCS patient selection for PCI is essential, particularly in Germany.