Arch Intern Med. 2012 Feb 27; 172(4): 312-9.
CAD remains a leading cause of morbidity and mortality worldwide. Previous studies have demonstrated a lack of PCI benefit in patient with stable CAD (1). In the current paper, the authors from Division of Cardiovascular Medicine, Department of Medicine, State University of New York-Stony Brook School of Medicine describe results from a meta-analysis of all randomized clinical trials comparing initial coronary stent implantation with medical therapy to determine the effect on death, nonfatal myocardial infarction (MI), unplanned revascularization, and persistent angina (2).
Eight prospective randomized trials enrolling a total of 7229 patients were identified. Three trials enrolled stable patients after MI, whereas 5 studies enrolled patients with stable angina and/or ischemia on stress testing. Mean weighted follow-up was 4.3 years. The respective event rates for death with stent implantation and medical therapy were 8.9% and 9.1% (OR, 0.98; 95% CI, 0.84-1.16); for nonfatal MI, 8.9% and 8.1% (OR, 1.12; 95% CI, 0.93-1.34); for unplanned revascularization, 21.4% and 30.7% (OR, 0.78; 95% CI, 0.57-1.06); and for persistent angina, 29% and 33% (OR, 0.80; 95% CI, 0.60-1.05).
The authors concluded that initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal MI, unplanned revascularization, or angina.
1. Boden WE, O'Rourke RA, Teo KK, et al. COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503-16.
2. Stergiopoulos K, Brown DL. Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery Disease: Meta-analysis of Randomized Controlled Trials. Arch Intern Med. 2012 Feb 27;172(4):312-9.
3. Boden WE. Mounting Evidence for Lack of PCI Benefit in Stable Ischemic Heart Disease:What More Will It Take to Turn the Tide of Treatment? Arch Intern Med. 2012;172:319-21.
4. Redberg RF. Informed Strategies for Treating Coronary Disease. Arch Intern Med. 2012 Feb 27;172(4):321. No abstract available.