Percutaneous Coronary Intervention Versus Conservative Therapy in Nonacute Coronary Artery Disease
- 7 June 2005
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation
- Vol. 111 (22), 2906-2912
- https://doi.org/10.1161/circulationaha.104.521864
Abstract
Background— Percutaneous coronary intervention (PCI) has been shown to improve symptoms compared with conservative medical treatment in patients with stable coronary artery disease (CAD); however, there is limited evidence on the effect of PCI on the risk of death, myocardial infarction, and subsequent revascularization. Therefore, we performed a meta-analysis of 11 randomized trials comparing PCI to conservative treatment in patients with stable CAD. Methods and Results— A total of 2950 patients were included in the meta-analysis (1476 received PCI, and 1474 received conservative treatment). There was no significant difference between the 2 treatment strategies with regard to mortality, cardiac death or myocardial infarction, nonfatal myocardial infarction, CABG, or PCI during follow-up. By random effects, the risk ratios (95% CIs) for the PCI versus conservative treatment arms were 0.94 (0.72 to 1.24), 1.17 (0.88 to 1.57), 1.28 (0.94 to 1.75), 1.03 (0.80 to 1.33), and 1.23 (0.80 to 1.90) for these 5 outcomes, respectively. A possible survival benefit was seen for PCI only in trials of patients who had a relatively recent myocardial infarction (risk ratio 0.40, 95% CI 0.17 to 0.95). Except for PCI during follow-up, there was no significant between-study heterogeneity for any outcome. Conclusions— In patients with chronic stable CAD, in the absence of a recent myocardial infarction, PCI does not offer any benefit in terms of death, myocardial infarction, or the need for subsequent revascularization compared with conservative medical treatment.This publication has 28 references indexed in Scilit:
- Meta-analysis comparing drug-eluting stents with bare metal stentsThe American Journal of Cardiology, 2005
- Indications for Coronary Artery Bypass Surgery and Percutaneous Coronary Intervention in Chronic Stable AnginaCirculation, 2003
- Randomized Comparison of Percutaneous Transluminal Coronary Angioplasty and Medical Therapy in Stable Survivors of Acute Myocardial Infarction With Single Vessel DiseaseCirculation, 2003
- Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysisBMJ, 2003
- Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular DiseaseCirculation, 2003
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- Bayesian random effects meta‐analysis of trials with binary outcomes: methods for the absolute risk difference and relative risk scalesStatistics in Medicine, 2002
- Two- to three-year follow-up of patients with single-vessel coronary artery disease randomized to PTCA or medical therapy (results of a VA cooperative study)The American Journal of Cardiology, 1998
- Rationale, Design, and Baseline Characteristics of a Trial Comparing Aggressive Lipid Lowering With Atorvastatin Versus Revascularization Treatments (AVERT)The American Journal of Cardiology, 1997
- The Medicine, Angioplasty or Surgery Study (MASS): A prospective, randomized trial of medical therapy, balloon angioplasty or bypass surgery for single proximal left anterior descending artery stenosesJournal of the American College of Cardiology, 1995