By Sahar Bedrood B.S. and Asher Kimchi M.D.

Athens, 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. Demosthenes 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 therapy.

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 medical therapy.

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 patient’s longevity does not increase with PCI.

Co-authors: Katritsis, Demosthenes G. MD, PhD; Ioannidis, John P.A. MD