Do heart procedures reduce the risk of heart attack and death in patients with chronic coronary disease compared to medication alone?

This study looked at the risk of heart attack or death in patients with chronic coronary disease (CAD) treated with revascularization procedures plus medication or medication alone. It found that revascularization procedures did not reduce the risk of death compared with medication alone, while coronary artery bypass grafting (CABG) with medication may reduce the risk of a heart attack.

CAD is a condition in which the heart does not get enough oxygen over a long period of time. It can lead to a heart attack or death. CAD can be treated with medication or revascularization procedures to open up the blocked blood vessels in the heart. This can be done through open-heart surgery which is called a coronary artery bypass graft (CABG). CABG replaces the blocked blood vessel with a piece of blood vessel from a different part of the body. It can also be done in a less invasive way called percutaneous coronary intervention (PCI). PCI uses a thin tube to place a small stent in the blocked blood vessel to keep it open.

It is not clear if this medication alone is as effective as having a revascularization procedure in patients with CAD.

This study looked at the results of 7 studies involving a total of 10,797 patients with CCS. Patients were followed for an average of 5 years to monitor for heart attacks or death. 5,413 patients had a revascularization procedure (either PCI or CABG) and medication. 5,384 patients had medical therapy alone.

Death occurred in 11.8% of patients who had a procedure and 12% of patients who had medication alone. Heart attacks occurred in 10.2% of patients who had a procedure and 11.6% of patients who had medical therapy alone. 

Looking at PCI and CABG groups separately, patients who had a CABG were 65% less likely to have a non-fatal heart attack than those treated with medication alone. Patients who had a PCI were only 8% less likely to have a non-fatal heart attack than the medication group.

This study showed that the risk of death in patients with CAD was the same in those treated with procedures plus medications as in those treated with medication alone. However, CABG significantly reduced the risk of heart attacks compared to medication alone.

Some studies included in this study did not provide detailed information on participants. Therefore this study was unable to compare different patient characteristics.