Revascularization plus medical therapy can reduce risks for stroke and heart attacks in patients with stable coronary artery disease

This study compared the effectiveness and risks of revascularization (RV) plus medical therapy (MT) to MT alone in patients with stable coronary artery disease (CAD). 

The study showed that RV plus MT can significantly reduce the risk of heart attack, stroke, and death.

Patients with CAD developed build-up in the arteries that transport blood with oxygen to the heart muscle. It leads to a high risk for heart attack (myocardial infarct; MI), stroke, and even death (mortality). 

Treatment options include revascularization (RV) and MT. RV involves surgical procedures such as percutaneous coronary intervention (PCI; when a stent is inserted to open up blocked blood vessels) and coronary-artery bypass grafting (CABG; when another blood vessel is used to redirect or bypass blood flow from the blocked vessel). The term MT describes various treatments, including lifestyle changes and drugs like acetylsalicylic acid (aspirin). Even with treatment, the risk remains high to experience MI, stroke, re-admissions to hospitals (rehospitalization), repeated RV, and death. 

MT and RV have been shown to decrease the risk for nonfatal-MI and increase survival rates in patients with CAD presenting acute and severe symptoms. Stable CAD usually has no symptoms or these appear rarely, during increased needs of blood supply to the heart such as during exercise. Stable CAD is commonly treated with MT only. However, it is unknown if MT alone or RV plus MT lead to improved effectiveness and lowered risks in patients with stable CAD.

The authors selected and evaluated the data from 12 studies. They included 15.774 patients with stable CAD from over 38 countries overall. The studies compared the effectiveness and risks of MT only to RV in combination with MT. The follow-up time was four years on average and ten years maximum. Measurements included the risk of mortality, MI, stroke, rehospitalization, additional need for RV. 

Eight studies showed that MT plus RV lowered the risk for mortality, MI, additional RV rehospitalization, and stroke for patients by 31% compared to MT only. The overall risk for death of any cause was not significantly reduced in patients receiving MT plus RV compared to MT only.

Ten of the evaluated studies showed a 47% lower risk for unplanned RV procedures and a 35% lower risk of MI resulting in death for MT plus RV compared to MT only. 

The authors concluded that RV plus MT can improve the outcomes of patients with stable CAD by reducing the risk for MI, stroke, admissions to hospitals, and the need for additional procedures.

Definitions for measures and outcomes might have varied across studies. Other relevant factors with influence might not have been included.

Ask your doctor for more information on MT in addition to RV and its relevance for your treatment.