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Initial optimal medical therapy with or without invasive strategy for stable coronary disease: a meta-analysis and

Mahmoud Barbarawi1, Ahmad Alabdouh2, Owais Barbarawi3

  • 1Department of Cardiology, University of Connecticut, Farmington, Connecticut.

Coronary Artery Disease
|April 7, 2021
PubMed

Insights

For stable coronary artery disease (CAD), an early invasive strategy with angiography did not lower mortality or heart attacks. However, it significantly reduced major adverse cardiovascular events (MACE) and unstable angina hospitalizations.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Stable coronary artery disease (CAD) management involves ongoing debate regarding the optimal timing and benefit of diagnostic angiography.
  • Comparing an initial invasive strategy with medical therapy alone is crucial for evidence-based clinical decision-making.

Purpose of the Study:

  • To evaluate the efficacy of an early invasive strategy versus medical therapy alone in patients with stable CAD.
  • To determine the impact on mortality, myocardial infarction (MI), and other major adverse cardiovascular events (MACE).

Main Methods:

  • A meta-analysis of randomized controlled trials (RCTs) was conducted using data from PubMed/MEDLINE, Cochrane Library, and Embase.
  • Included RCTs compared early invasive approach with medical therapy alone in stable CAD patients.
  • Primary outcomes were all-cause mortality and MI; secondary outcomes included MACE, cardiovascular mortality, hospitalizations, and revascularization events.

Main Results:

  • The early invasive strategy did not significantly reduce all-cause mortality (RR, 0.94; 95% CI, 0.84-1.05) or MI (RR, 0.93; 95% CI, 0.79-1.10).
  • No significant reduction was observed in cardiovascular mortality, cardiovascular hospitalization, or revascularization rates.
  • However, the incidence of MACE (RR, 0.79; 95% CI, 0.63-0.99) and hospitalization for unstable angina (RR, 0.46; 95% CI, 0.32-0.67) were significantly lower with the early invasive strategy.

Conclusions:

  • An early invasive strategy in stable CAD patients with significant stenosis does not improve all-cause mortality or MI rates compared to medical therapy alone.
  • The early invasive approach significantly decreases the occurrence of MACE and hospitalizations due to unstable angina.
  • These findings suggest a nuanced approach to invasive strategies in stable CAD, focusing on event reduction beyond mortality and MI.
Abstract

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