Published online before print May 31, 2005, doi: 10.1161/CIRCULATIONAHA.104.521864
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2005;111:2906-2912.)
© 2005 American Heart Association, Inc.
Coronary Heart Disease |
Percutaneous Coronary Intervention Versus Conservative Therapy in Nonacute Coronary Artery Disease
A Meta-Analysis
From the Department of Cardiology, Athens Euroclinic, Athens, Greece (D.G.K.); the Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece (J.P.A.I.); Biomedical Research Institute, Foundation for Research and Technology—Hellas, Ioannina, Greece (J.P.A.I.); and the Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Tufts University School of Medicine, Boston, Mass (J.P.A.I.).
Correspondence to John P.A. Ioannidis, MD, Professor and Chairman, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina 45110, Greece. E-mail jioannid{at}cc.uoi.gr
Received November 16, 2004; revision received February 14, 2005; accepted February 22, 2005.
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.
Key Words: meta-analysis • angioplasty • myocardial infarction • mortality
Related Article:
Circulation 2005 111: 2865.
This article has been cited by other articles:
 |
|
 |
|
  W. J. Gomes Increased perioperative mortality in elective coronary artery bypass grafting after previous percutaneous coronary intervention. J. Thorac. Cardiovasc. Surg., November 1, 2009; 138(5): 1253 - 1253. [Full Text] [PDF]
|
|
|
|
 |
|
 T. S. S. Genders, W. B. Meijboom, M. F. L. Meijs, J. D. Schuijf, N. R. Mollet, A. C. Weustink, F. Pugliese, J. J. Bax, M. J. Cramer, G. P. Krestin, et al. CT Coronary Angiography in Patients Suspected of Having Coronary Artery Disease: Decision Making from Various Perspectives in the Face of Uncertainty Radiology, October 28, 2009; (2009) radiol.2533090507v1. [Abstract] [Full Text]
|
|
|
|
 |
|
 D. G. Katritsis, G. C.M. Siontis, and J. P.A. Ioannidis Double Versus Single Stenting for Coronary Bifurcation Lesions: A Meta-Analysis Circ Cardiovasc Interv, October 1, 2009; 2(5): 409 - 415. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Swedberg Fallacies in clinical cardiovascular trials Heart, September 1, 2009; 95(17): 1464 - 1468. [Full Text] [PDF]
|
|
|
|
|
|
K. A A Fox COURAGE to change practice? Revascularisation in patients with stable coronary artery disease Heart, May 1, 2009; 95(9): 689 - 692. [Full Text] [PDF]
|
|
|
|
 |
|
 B. Horst, C. S. Rihal, D. R. Holmes Jr, J. F. Bresnahan, A. Prasad, G. Gau, R. Lennon, and A. Lerman Comparison of Drug-Eluting and Bare-Metal Stents for Stable Coronary Artery Disease J. Am. Coll. Cardiol. Intv., April 1, 2009; 2(4): 321 - 328. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-C. Tardif, P. Ponikowski, T. Kahan, and for the ASSOCIATE study Investigators Efficacy of the If current inhibitor ivabradine in patients with chronic stable angina receiving beta-blocker therapy: a 4-month, randomized, placebo-controlled trial Eur. Heart J., March 1, 2009; 30(5): 540 - 548. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. C. Wijeysundera and D. T. Ko Does Percutaneous Coronary Intervention Reduce Mortality in Patients With Stable Chronic Angina: Are We Talking About Apples and Oranges? Circ Cardiovasc Qual Outcomes, March 1, 2009; 2(2): 123 - 126. [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Ellis Refining the Art and Science of Coronary Stenting N. Engl. J. Med., January 15, 2009; 360(3): 292 - 294. [Full Text] [PDF]
|
|
|
|
 |
|
 F. Crea, P. G. Camici, R. De Caterina, and G. A. Lanza CHAPTER 17 Chronic Ischaemic Heart Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F.L. Lucas, A.E. Siewers, D.J. Malenka, and D.E. Wennberg Diagnostic-Therapeutic Cascade Revisited: Coronary Angiography, Coronary Artery Bypass Graft Surgery, and Percutaneous Coronary Intervention in the Modern Era Circulation, December 16, 2008; 118(25): 2797 - 2802. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. A. Lin, R. A. Dudley, F. L. Lucas, D. J. Malenka, E. Vittinghoff, and R. F. Redberg Frequency of Stress Testing to Document Ischemia Prior to Elective Percutaneous Coronary Intervention JAMA, October 15, 2008; 300(15): 1765 - 1773. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Nishigaki, T. Yamazaki, A. Kitabatake, T. Yamaguchi, K. Kanmatsuse, I. Kodama, N. Takekoshi, H. Tomoike, M. Hori, M. Matsuzaki, et al. Percutaneous Coronary Intervention Plus Medical Therapy Reduces the Incidence of Acute Coronary Syndrome More Effectively Than Initial Medical Therapy Only Among Patients With Low-Risk Coronary Artery Disease: A Randomized, Comparative, Multicenter Study J. Am. Coll. Cardiol. Intv., October 1, 2008; 1(5): 469 - 479. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. G. Katritsis and B. Meier Percutaneous Coronary Intervention for Stable Coronary Artery Disease J. Am. Coll. Cardiol., September 9, 2008; 52(11): 889 - 893. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schomig, J. Mehilli, A. de Waha, M. Seyfarth, J. Pache, and A. Kastrati A Meta-Analysis of 17 Randomized Trials of a Percutaneous Coronary Intervention-Based Strategy in Patients With Stable Coronary Artery Disease J. Am. Coll. Cardiol., September 9, 2008; 52(11): 894 - 904. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Kirtane and D. J. Cohen When Is Better Not Good Enough?: Insights From the COURAGE Economic Study Circ Cardiovasc Qual Outcomes, September 1, 2008; 1(1): 4 - 6. [Full Text] [PDF]
|
|
|
|
|
|
W. S. Weintraub, W. E. Boden, Z. Zhang, P. Kolm, Z. Zhang, J. A. Spertus, P. Hartigan, E. Veledar, C. Jurkovitz, J. Bowen, et al. Cost-Effectiveness of Percutaneous Coronary Intervention in Optimally Treated Stable Coronary Patients Circ Cardiovasc Qual Outcomes, September 1, 2008; 1(1): 12 - 20. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. W. Payne Jr., L. Littmann, S. Burtey, B. Dussol, P. Brunet, S. K. Goyal, S. R. Punnam, K. Nasir, M. J. Budoff, R. Blumenthal, et al. Coronary Calcium and Events in Four Ethnic Groups N. Engl. J. Med., July 10, 2008; 359(2): 202 - 204. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Coylewright, R. S. Blumenthal, and W. Post Placing COURAGE in Context: Review of the Recent Literature on Managing Stable Coronary Artery Disease Mayo Clin. Proc., July 1, 2008; 83(7): 799 - 805. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Brett Coronary Assessment Before Noncardiac Surgery: Current Strategies Are Flawed Circulation, June 17, 2008; 117(24): 3145 - 3151. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Holmvang and H. Mickley Review: Gender differences following percutaneous coronary intervention Therapeutic Advances in Cardiovascular Disease, April 1, 2008; 2(2): 109 - 113. [Abstract] [PDF]
|
|
|
|
|
|
D. P. Taggart, S. Kaul, W. E. Boden, T. B. Ferguson Jr, R. A. Guyton, M. J. Mack, P. T. Sergeant, R. J. Shemin, P. K. Smith, and S. Yusuf Revascularization for unprotected left main stem coronary artery stenosis stenting or surgery. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 885 - 892. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Kertai Preoperative Coronary Revascularization in High-Risk Patients Undergoing Vascular Surgery: A Core Review Anesth. Analg., March 1, 2008; 106(3): 751 - 758. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Ohno, S. Takamoto, and N. Motomura Diabetic Retinopathy and Coronary Artery Disease From the Cardiac Surgeon's Perspective Ann. Thorac. Surg., February 1, 2008; 85(2): 681 - 689. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Holmes Jr, B. J. Gersh, P. Whitlow, S. B. King III, and J. T. Dove Percutaneous coronary intervention for chronic stable angina a reassessment. J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 34 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. L. Brown, T. M. Sundt III, and B. J. Gersh Indications for Revascularization Card. Surg. Adult, January 1, 2008; 3(2008): 551 - 572. [Full Text]
|
|
|
|
 |
|
 D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery Ann Intern Med, November 20, 2007; 147(10): 703 - 716. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ignace Jr, N. Girerd Jr, and D. Fouque Good Evidence Evaluation for Good Risk Assessment Arch Intern Med, October 22, 2007; 167(19): 2146 - 2147. [Full Text] [PDF]
|
|
|
|
|
|
G. A. Diamond and S. Kaul COURAGE Under Fire: On the Management of Stable Coronary Disease J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1604 - 1609. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Kereiakes, P. S. Teirstein, I. J. Sarembock, D. R. Holmes Jr, M. W. Krucoff, W. W. O'Neill, R. Waksman, D. O. Williams, J. J. Popma, M. Buchbinder, et al. The Truth and Consequences of the COURAGE Trial J. Am. Coll. Cardiol., October 16, 2007; 50(16): 1598 - 1603. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. B Mark Percutaneous coronary revascularisation: is it ever worth what it costs? Heart, October 1, 2007; 93(10): 1161 - 1163. [Full Text] [PDF]
|
|
|
|
|
|
G. A. Lin, R. A. Dudley, and R. F. Redberg Cardiologists' Use of Percutaneous Coronary Interventions for Stable Coronary Artery Disease Arch Intern Med, August 13, 2007; 167(15): 1604 - 1609. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Pitt Percutaneous coronary intervention plus optimal medical therapy was not more effective than medical therapy alone in stable CAD Evid. Based Med., August 1, 2007; 12(4): 107 - 107. [Full Text] [PDF]
|
|
|
|
|
|
D. G. Katritsis, J. P.A. Ioannidis, T. P. Wharton Jr., V. A. Umans, H. O. Peels, A. P. Shah, D. M. Shavelle, W. J. French, S. De Servi, H. Kiat, et al. PCI for Stable Coronary Disease N. Engl. J. Med., July 26, 2007; 357(4): 414 - 418. [Full Text] [PDF]
|
|
|
|
|
|
S. Kaul, P. K. Shah, and G. A. Diamond As Time Goes By: Current Status and Future Directions in the Controversy Over Stenting J. Am. Coll. Cardiol., July 10, 2007; 50(2): 128 - 137. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Ben-Dor and A. Battler Treatment of stable angina Heart, July 1, 2007; 93(7): 868 - 874. [Full Text] [PDF]
|
|
|
|
|
|
N. H.J. Pijls, P. van Schaardenburgh, G. Manoharan, E. Boersma, J.-W. Bech, M. van't Veer, F. Bar, J. Hoorntje, J. Koolen, W. Wijns, et al. Percutaneous Coronary Intervention of Functionally Nonsignificant Stenosis: 5-Year Follow-Up of the DEFER Study J. Am. Coll. Cardiol., May 29, 2007; 49(21): 2105 - 2111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Hochman and P. G. Steg Does Preventive PCI Work? N. Engl. J. Med., April 12, 2007; 356(15): 1572 - 1574. [Full Text] [PDF]
|
|
|
|
|
|
W. E. Boden, R. A. O'Rourke, K. K. Teo, P. M. Hartigan, D. J. Maron, W. J. Kostuk, M. Knudtson, M. Dada, P. Casperson, C. L. Harris, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease N. Engl. J. Med., April 12, 2007; 356(15): 1503 - 1516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. K. Nallamothu, M. A. M. Rogers, M. E. Chernew, H. M. Krumholz, K. A. Eagle, and J. D. Birkmeyer Opening of Specialty Cardiac Hospitals and Use of Coronary Revascularization in Medicare Beneficiaries JAMA, March 7, 2007; 297(9): 962 - 968. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Hueb, N. H. Lopes, B. J. Gersh, P. Soares, L. A.C. Machado, F. B. Jatene, S. A. Oliveira, and J. A.F. Ramires Five-Year Follow-Up of the Medicine, Angioplasty, or Surgery Study (MASS II): A Randomized Controlled Clinical Trial of 3 Therapeutic Strategies for Multivessel Coronary Artery Disease Circulation, March 6, 2007; 115(9): 1082 - 1089. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. L. Gould Physiological severity of coronary artery stenosis Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2583 - H2585. [Full Text] [PDF]
|
|
|
|
|
|
H. M. Krumholz and F. A. Masoudi The Year in Epidemiology, Health Services Research, and Outcomes Research J. Am. Coll. Cardiol., November 7, 2006; 48(9): 1886 - 1895. [Full Text] [PDF]
|
|
|
|
|
|
W. J. Gomes and E. Buffolo Coronary stenting and inflammation: implications for further surgical and medical treatment. Ann. Thorac. Surg., May 1, 2006; 81(5): 1918 - 1925. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. Clouse, J. Chen, H. M. Krumholz, M. E. Clouse, J. Chen, and H. M. Krumholz Noninvasive Screening for Coronary Artery Disease With Computed Tomography Is Useful Circulation, January 3, 2006; 113(1): 125 - 146. [Full Text] [PDF]
|
|
|
|
|
|
S. B. King III Angioplasty Is Better Than Medical Therapy for Alleviating Chronic Angina Pectoris Arch Intern Med, December 12, 2005; 165(22): 2589 - 2592. [Full Text] [PDF]
|
|
|
|
 |
|
 Is PCI Overused in Patients with Stable CAD? Journal Watch Cardiology, July 29, 2005; 2005(729): 3 - 3. [Full Text]
|
|