Percutaneous Coronary Intervention versus Optimal Medical Therapy for Prevention of Spontaneous Myocardial Infarction in Subjects with Stable Ischemic Heart Disease
Background—Contemporary studies have shown that spontaneous but not procedural myocardial infarction (MI) are related to subsequent mortality. Whether PCI reduces spontaneous (non-procedural) MI is unknown.
Methods and Results—PUBMED, EMBASE, and CENTRAL were searched for randomized clinical trials (RCTs), until October 2012, comparing PCI with OMT, for stable ischemic heart disease, and reporting MI outcomes - spontaneous non-procedural MI, procedural MI and all MI including procedure related MI. Given the varying length of follow-up between trials, a mixed-effect poisson regression meta-analysis was employed. From 12 RCTs with 37548 patient-years of follow-up, PCI, when compared with OMT alone, was associated with significant lower incident rate ratio (IRR) for spontaneous non-procedural MI (IRR=0.76, 95% CI 0.58-0.99) at the risk of higher procedural MI (IRR=4.11, 95% CI 2.53-6.88) without any difference in all MI (IRR=0.96, 95% CI 0.74-1.21). The point estimate for PCI vs. OMT for all-cause mortality (IRR=0.88, 95% CI 0.75-1.03) and cardiovascular mortality (IRR=0.70, 95% CI 0.44-1.09) paralleled that of spontaneous non-procedural MI (but not procedural or all nonfatal MI) although these were not statistically significant.
Conclusions—PCI compared to OMT reduced spontaneous MI at the risk of procedural MI without any difference in all MI. Consistent with prior studies showing that spontaneous MI but not procedural MI are related to subsequent mortality, in the present report the point estimate for reduced mortality with PCI compared to OMT paralleled the prevention of spontaneous MI with PCI. Further studies are needed to determine whether these associations are causal.
- periprocedural myocardial infarction
- optimal medical therapy
- percutaneous coronary intervention
- myocardial infarction
- ischemic heart disease
- Received July 18, 2012.
- Revision received January 10, 2013.
- Accepted January 10, 2013.
- Copyright © 2013, Circulation