Background:
The role of Percutaneous Coronary Intervention (PCI) in acute coronary syndromes is well established, but more controversial in stable ischemic heart disease (SIHD). We investigated the outcomes of Myocardial Infarction (MI) / death and all-cause mortality among published trials that compared PCI with optimal medical therapy (OMT).
Methods:
We retrieved all published papers that compared PCI with OMT in patients with SIHD or post-MI. Three clinician-researchers independently reviewed and abstracted a total of 110 articles meeting our inclusion criteria. 17 randomized controlled trials (RCT) published between 2000 and 2012 were analyzed by Bayesian random effects meta-analysis.
Results:
21,256 patients were analyzed: 11,502 had PCI and 9,754 OMT. There was no difference between PCI and OMT for the combined outcome of MI/death across all trials (RR = 0.99, 95% CI = 0.72-1.33, p = 0.98), although there was a trend for benefit with PCI all-cause mortality (RR = 0.81, 95% CI = 0.64-1.05, p = 0.48). When trials were analyzed by patient population, SIHD or post-MI, the trend for mortality benefit was noted only for the post-MI patients (Table 1).
Conclusion:
PCI did not yield any additional benefit above OMT for the end points of MI/Death or all-cause mortality in SIHD. However, there was a trend for reduced mortality with PCI in post-MI patients.
Bayesian meta-analysis of percutaneous coronary intervention compared to optimal medical therapy in stable ischemic heart disease patients
