Percutaneous coronary intervention versus medical therapy in stable angina: a matched cohort study
Sang-Ho Jo1, Hoseob Kim2, Hyun-Jin Kim3
1Department of Internal Medicine/ Division of Cardiology, Hallym University Sacred Heart Hospital, Anyang, Korea (the Republic of) sophi5neo@gmail.com.
Insights
Percutaneous coronary intervention (PCI) with optimal medical therapy (OMT) did not reduce adverse events compared to OMT alone in stable angina patients. PCI was associated with higher rates of myocardial infarction, stroke, and cardiac death over 9.3 years.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Stable angina pectoris affects a significant population, necessitating effective long-term management strategies.
- Optimal medical therapy (OMT) is the cornerstone of stable angina treatment.
- The role of percutaneous coronary intervention (PCI) in addition to OMT for pure stable angina remains debated regarding long-term outcomes.
Purpose of the Study:
- To investigate the long-term efficacy of percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) versus OMT alone in patients with pure stable angina.
- To compare the rates of major adverse clinical events between the two treatment strategies.
Main Methods:
- A large-scale retrospective study using Korean national insurance data from 2006 to 2010.
- 5673 patients receiving PCI plus OMT were propensity-matched 1:1 with 5673 patients receiving OMT alone.
- Patients had pure stable angina, no prior myocardial infarction (MI), and no prior PCI, with a follow-up duration of 9.3 years.
Main Results:
- The primary endpoint (MI, stroke, cardiac death) was significantly higher in the PCI group (13.5/1000 person-years) compared to the OMT group (11.5/1000 person-years; HR 1.18).
- Individual event rates for MI and cardiac death were also higher in the PCI group.
- Revascularization and total death rates were substantially greater in the PCI group.
Conclusions:
- Percutaneous coronary intervention (PCI) in addition to optimal medical therapy (OMT) is associated with an increased risk of major adverse clinical events in patients with pure stable angina.
- OMT alone appears to be a safer long-term strategy for this patient population.
- These findings suggest a re-evaluation of routine PCI use in stable angina patients without a history of MI or prior PCI.
Objective:
It is uncertain whether percutaneous coronary intervention (PCI) in addition to optimal medical therapy (OMT) can reduce adverse clinical events in the long term as compared with OMT alone in patients with pure stable angina.
Methods:
We enrolled patients from 2006 to 2010 using the Korean national insurance data. 58 742 patients with pure stable angina with no history of myocardial infarction (MI) nor PCI were candidate, and finally, 5673 patients in the PCI plus OMT group and 5673 in the OMT alone group were selected with 1:1 propensity matching. They were followed up for 9.3 years.
Results:
Primary endpoint, a composite of MI, stroke and cardiac death rate was significantly higher in the PCI group than in the OMT group, 13.5/1000 vs 11.5/1000 person-year with HR of 1.18 (95% CI 1.06 to 1.32, p=0.003). Individual event rate of MI and cardiac death rate was higher in the PCI group than in the OMT group at 9.3 years, 2.9 vs 2.1 (HR 1.38, 95% CI 1.09 to 1.7, p=0.009) and 4.8 vs 3.4/1000 person-year (HR 1.40, 95% CI 1.16 to 1.69, p=0.001), respectively. Revascularisation and total death occurred more in the PCI group as compared with the OMT group, 30.3 vs 8.2 (HR 3.64, 95% CI 3.27 to 4.05, p<0.001) and 13.5 vs 10.6/1000 person-year (HR 1.23, 95% CI 1.12 to 1.40, p<0.001), respectively. In subgroup analysis, the same trend of more event in the PCI group was detected.
Conclusions:
PCI plus OMT was associated with higher rate of primary endpoint of MI, stroke, cardiac death as compared with OMT alone in patients with pure stable angina at 9.3-year follow-up in large population.
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