June 8, 2005
Bedrood B.S. and Asher Kimchi M.D.
Greece- In patients with chronic stable coronary artery disease,
percutaneous coronary intervention (PCI) has shown to improve
symptoms compared with conservative medical treatment. However,
the risk of death, myocardial infarction and revascularization
had not been assessed until recently.
Katritsis MD, PhD and John Ioannidis P.A. MD from the Athens
Euroclinic in Greece performed a meta-analysis of 11 randomized
trials comparing PCI with conservative therapy. In a paper
published in the
June 7, 2005
issue of Circulation, this study determined that in
patients with chronic stable coronary artery disease, PCI did
not offer any benefits in terms of death, myocardial infarction
or revascularization when compared to conservative medical
There have been
many previous studies that indicated a significant improvement
of anginal symptoms with PCI in patients with coronary artery
disease. However, this study focused on the improvement of
mortality and risk of subsequent myocardial infarction in
patients who underwent PCI compared to those who underwent
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).
The study thus indicates there is no significant difference
in mortality or risk of MI in patients who underwent PCI as
compared to patients who underwent conservative medical
treatment. When comparing such treatment options, one must
consider the greater financial cost and risk of in-hospital
mortality with PCI. While symptoms may improve, the patientís
longevity does not increase with PCI.