Medical Management Versus PCI in Patients with Stable Angina: An Updated Systematic Review and Meta-analysis

BACKGROUND: Despite the clinical guidelines favoring medical therapy for stable angina, the optimal management of these patients remains unclear. Here, we compare medical management (MM) versus percutaneous coronary intervention (PCI) in patients with stable angina. METHODS: An extensive literature search was conducted using PubMed and Embase to identify randomized controlled trials of interest. Data were extracted and analyzed using a random-effects model to calculate pooled odds ratios (OR). RESULTS: Our meta-analysis of 28 randomized controlled trials included 9346 PCI patients and 9503 medically managed patients. The mean age was 62.5 ± 7.6 years in the PCI group and 62.8 ± 7.4 years in the other group. Men comprised 68% and 70% of the PCI and MM groups, respectively.Over a mean follow-up of 2.64 years, PCI was associated with a significantly lower incidence of myocardial infarction compared with MM (OR, 0.84; 95% CI, 0.74-0.96; P = 0.01). Although PCI showed trends toward lower odds of unplanned revascularizations and major adverse cardiovascular (CV) events, these differences were not statistically significant. There were no differences in outcomes of freedom from angina, unstable angina, nonfatal myocardial infarction, stroke, all-cause mortality, or CV death. CONCLUSION: Advances in CV imaging and catheterization techniques have improved risk stratification and outcomes of PCI in stable angina. Further research is needed to identify clinical subgroups that benefit most from each treatment modality.