PCI shows no additional benefit over standard medical therapy in stable coronary artery disease

This study compared the effects of percutaneous coronary intervention (PCI) and standard medical therapy among patients with stable coronary artery disease.

Coronary artery disease, characterized by narrowing of the arteries and disrupted blood supply to the heart muscle, is a leading cause of death worldwide. Therefore, many therapies aim to restore optimal blood supply in order to reduce the risk of future heart attacks and relieve common symptoms such as chest pain. Standard medical therapy used to treat coronary artery disease may include drugs which dilate blood vessels (thus increasing blood supply to the heart muscle), lower heart rate and blood pressure (thus decreasing the hearts energy requirements and needed blood supply), and decrease cholesterol production (which plays a major role in the progression of coronary artery disease).

Percutaneous coronary intervention (PCI) is a more invasive approach in the treatment of coronary artery disease. PCI can restore normal blood flow by inserting a small catheter equipped with an inflatable balloon (through an artery in the hand or thigh) into the narrowed artery of the heart. Often, a stent (a small mesh tube) is placed within the vessel to help keep the artery open. Since PCI is considered a minimally invasive and low-risk procedure, with proven benefit, it is often offered to patients suffering from stable disease to reduce the risk of future life-threatening events. However, recent trials have suggested that PCI may not offer any additional benefit over standard medical therapy among stable patients.

This analysis compared the effect of PCI in addition to standard medical therapy with medical therapy alone among patients with proven coronary artery disease. 5 randomly controlled trails, including a total of 4,064 patients, were reviewed in this analysis. 2,016 patients were randomized to undergo PCI in addition to recommended medical therapy, while 2,048 patients were randomized to receive medical therapy alone. Over an average follow-up of 5-years, 132 (6.5%) deaths occurred among the 2,016 patients randomized to undergo PCI, compared to 149 (7.3%) deaths among the 2,048 patients randomized to medical therapy alone. However this difference was not found to be significant on statistical analysis. Non-fatal heart attacks were reported in 187 (9.2%) of the 2,016 patients undergoing PCI compared with 156 (7.6%) of the 2,048 patients receiving medical therapy alone. Statistical analysis concluded that the risk of non-fatal heart attacks was increased by 24% among patients undergoing PCI, compared to those receiving medical therapy alone. No significant difference was noted in the incidence of chest pain between treatment groups.

This analysis concluded that among patients with stable coronary artery disease, PCI in addition to medical therapy does not result in significant reductions in the risk of mortality, heart attacks or chest pain compared with standard medical therapy alone.