Popular procedures without evidence of benefit: A case study of percutaneous coronary intervention for stable...

Area of Science:

• Cardiology
• Interventional Cardiology
• Health Services Research

Background:

• Percutaneous coronary intervention (PCI) is commonly performed in stable coronary artery disease (CAD) despite evidence of limited benefit.
• Utilization rates of PCI are increasing in Europe and often exceed those in the U.S.
• Optimal medical therapy (OMT) and lifestyle modifications remain underutilized as first-line treatments for stable CAD.

Purpose of the Study:

• To review the evidence comparing PCI to OMT in stable CAD.
• To analyze utilization patterns of PCI in stable CAD.
• To identify interventions for aligning clinical practice with evidence-based recommendations.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) and systematic reviews.
• Analysis of appropriate use criteria (AUC) and professional society guidelines.
• Examination of PCI utilization data and trends.

Main Results:

• Evidence suggests limited incremental benefit of PCI over OMT in stable CAD.
• PCI is often performed for uncertain or inappropriate indications.
• Significant disparities exist in PCI utilization rates across countries.

Conclusions:

• Current practice for stable CAD often deviates from evidence-based recommendations.
• There is a critical need to promote OMT and lifestyle changes.
• Interventions are required to optimize PCI use and improve patient outcomes in stable CAD.