Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease - A meta-analysis

Article

关键词: ACUTE MYOCARDIAL-INFARCTION;    HIERARCHICAL BAYESIAN METAANALYSIS;    SINGLE-VESSEL DISEASE;    DRUG-ELUTING STENTS;    MEDICAL THERAPY;    RANDOMIZED-TRIAL;    BYPASS-SURGERY;    FOLLOW-UP;    BALLOON ANGIOPLASTY;    STABLE ANGINA;   

DOI  :  10.1161/CIRCULATIONAHA.104.521864

来源: SCIE

【 摘 要 】

Background-Percutaneous coronary intervention (PCI) has been shown to improve symptoms compared with conservative medical treatment in patients with stable coronary artery disease (CAD); however, there is limited evidence on the effect of PCI on the risk of death, myocardial infarction, and subsequent revascularization. Therefore, we performed a meta-analysis of 11 randomized trials comparing PCI to conservative treatment in patients with stable CAD. Methods and Results-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). Except for PCI during follow-up, there was no significant between-study heterogeneity for any outcome. Conclusions-In patients with chronic stable CAD, in the absence of a recent myocardial infarction, PCI does not offer any benefit in terms of death, myocardial infarction, or the need for subsequent revascularization compared with conservative medical treatment.

【 授权许可】

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