on May 31, 2005
Published online before print May 31, 2005, doi: 10.1161/CIRCULATIONAHA.104.521864
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Submitted on November 16, 2004
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.). * To whom correspondence should be addressed. E-mail: jioannid{at}cc.uoi.gr.
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.
Revised on February 14, 2005
Accepted on February 22, 2005
Percutaneous Coronary Intervention Versus Conservative Therapy in Nonacute Coronary Artery Disease. A Meta-Analysis
Demosthenes G. Katritsis MD, PhD and John P.A. Ioannidis MD*
Key words: meta-analysis • angioplasty • myocardial infarction • mortality
Related Article:
Circulation 2005 111: 2865.
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