Key result
PCI shows no all-cause mortality benefit over medical therapy alone in SOCAD patients.
Why the study?
The optimal treatment for stable obstructive coronary artery disease remains controversial, and studies have not demonstrated an improvement in outcomes by adding percutaneous coronary intervention to optimal medical therapy.
Does percutaneous coronary intervention plus optimal medical therapy reduce mortality or myocardial infarction compared to optimal medical therapy alone in patients with stable obstructive coronary artery disease?
Meta-Analysis (n=11,144)
Does percutaneous coronary intervention plus optimal medical therapy reduce mortality or myocardial infarction compared to optimal medical therapy alone in patients with stable obstructive coronary artery disease?
In patients with stable obstructive coronary artery disease, adding PCI to optimal medical therapy does not improve all-cause mortality, cardiovascular mortality, or the incidence of myocardial infarction.
PCI adds no mortality or MI benefit in stable CAD; reinforces OMT as first-line therapy and confirms prior RCTs.
BACKGROUND: The optimal treatment for patients suffering from stable obstructive coronary artery disease (SOCAD) is controversial. Many studies have examined the value of performing percutaneous coronary intervention (PCI) in these patients but so far no study has been able to demonstrate an improvement in outcomes by performing PCI in addition to optimal medical therapy (OMT). This study aimed to examine the added value of performing PCI plus OMT vs. OMT alone regarding cardiovascular outcomes. METHODS AND RESULTS: We performed a systematic search and a meta-analysis for randomized controlled trials comparing PCI plus OMT vs. OMT in SOCAD patients. We included six trials (N = 11 144) with follow-up ranges 2.2-11.4 years. The pooled analysis showed no significant difference between PCI + OMT vs. OMT group regarding all-cause mortality, odds ratio (OR) = 0.98 [confidence interval (CI) 0.86-1.12, P = 0.79, I2 = 0%]. In addition, we have found no difference between the two groups regarding cardiovascular mortality, OR = 0.91 (CI 0.76-1.08, P = 0.27, I2 = 24%). Moreover, there was no difference in the incidence of myocardial infarction, OR = 0.92 (CI 0.81-1.04, P = 0.18, I2 = 49%). CONCLUSION: Our results suggest that there is no improvement in cardiovascular outcomes of patients with SOCAD by performing PCI plus OMT vs. OMT alone. This study provides an insight that should be taken under consideration in the management of SOCAD patients.
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Lerman et al. (2021) conducted a meta-analysis in stable obstructive coronary artery disease (SOCAD) (n=11,144). Percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) vs. Optimal medical therapy (OMT) alone was evaluated on all-cause mortality (OR 0.98, 95% CI 0.86-1.12, p=0.79). PCI plus optimal medical therapy did not significantly reduce all-cause mortality compared to medical therapy alone in SOCAD patients (OR 0.98; 95% CI 0.86-1.12; P=0.79).
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