The State of Percutaneous Intervention in Stable Coronary Artery Disease

This review examines trials of percutaneous coronary intervention (PCI) compared with optimal medical therapy (OMT) in order to inform clinical decision-making regarding the role of PCI in stable ischemic heart disease (SIHD).

Several large, randomized, controlled trials published in recent years suggest that OMT should be the initial treatment strategy for symptomatic SIHD, but there is a role for PCI in patients who continue to be symptomatic despite OMT. Additionally, using fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) techniques may help to identify physiologically significant lesions and may be useful in maximizing the benefit from PCI in SIHD. Recent trials demonstrate PCI for the treatment of symptomatic SIHD does not reduce mortality compared with OMT but effectively relieves anginal symptoms. However, OMT continues to be the first-line therapy for SIHD but is significantly underutilized.