Key result
In patients with chronic stable CAD, adding PCI to optimal medical therapy did not improve all-cause mortality (RR 0.96; 95% CI 0.87-1.08) compared to medical therapy alone.
Why the study?
Whether PCI improves clinical outcomes in stable CAD has been investigated for decades, and newly reported results from ISCHEMIA provided an opportunity to assess the incremental benefit of revascularization.
Does PCI added to OMT reduce mortality or MI in patients with stable CAD?
Meta-Analysis (n=12,125)
Does PCI added to OMT reduce mortality or MI in patients with stable CAD?
Relative Risk: 0.96 (95% CI 0.87–1.08)
In patients with stable CAD, adding PCI to optimal medical therapy does not improve survival or reduce MI, but it does improve anginal symptoms and reduce the need for subsequent revascularization.
Supports deferring routine PCI for survival in stable CAD; confirms prior RCTs showing equivalent mortality with OMT alone.
BACKGROUND: Whether percutaneous coronary intervention (PCI) improves clinical outcomes in patients with chronic angina and stable coronary artery disease (CAD) has been a continuing area of investigation for more than two decades. The recently reported results of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches, the largest prospective trial of optimal medical therapy (OMT) with or without myocardial revascularization, provides a unique opportunity to determine whether there is an incremental benefit of revascularization in stable CAD patients. METHODS: Scientific databases and websites were searched to find randomized clinical trials (RCTs). Pooled risk ratios were calculated using the random-effects model. RESULTS: Data from 10 RCTs comprising 12 125 patients showed that PCI, when added to OMT, were not associated with lower all-cause mortality (risk ratios, 0.96; 95% CI, 0.87-1.08), cardiovascular mortality (risk ratios, 0.91; 95% CI, 0.79-1.05) or myocardial infarction (MI) (risk ratios, 0.90; 95% CI, 0.78-1.04) as compared with OMT alone. However, OMT+PCI was associated with improved anginal symptoms and a lower risk for revascularization (risk ratios, 0.52; 95% CI, 0.37-0.75). CONCLUSIONS: In patient with chronic stable CAD (without left main disease or reduced ejection fraction), PCI in addition to OMT did not improve mortality or MI compared to OMT alone. However, this strategy is associated with a lower rate of revascularization and improved anginal symptoms.
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A 2021 study conducted a meta-analysis in Chronic stable coronary artery disease (n=12,125). Percutaneous coronary intervention (PCI) + optimal medical therapy (OMT) vs. Optimal medical therapy (OMT) alone was evaluated on All-cause mortality (RR 0.96, 95% CI 0.87-1.08). In patients with chronic stable CAD, adding PCI to optimal medical therapy did not improve all-cause mortality (RR 0.96; 95% CI 0.87-1.08) compared to medical therapy alone.
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