Journal of Family Practice - Does PCI added to drug therapy improve outcomes in stable CAD?
* Clinical question
Do percutaneous coronary interventions (PCIs) improve outcomes when added to optimal medical therapy for patients with stable coronary disease?
* Bottom line
No. Optimal medical therapy–treatment with a statin, an antiplatelet agent, an anti-anginal medication, and an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker–was as effective as pairing it with percutaneous coronary interventions (PCIs) for patients with stable coronary artery disease (CAD).
Level of evidence
1b: Individual randomized controlled trial (with narrow confidence interval)
Study design
Randomized controlled trial (single-blinded)
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Funding
Industry and government
Allocation
Concealed
Setting
Outpatient (specialty)
Synopsis
Despite the fact that guidelines recommend optimal medical therapy as the first-line treatment for stable CAD, 85% of patients undergoing PCI each year have stable CAD as the indication.
In this study, 2287 patients with stable angina were randomly assigned to receive intensive medical therapy or PCI followed by the same course of intensive medical therapy. All had at least 1 proximal vessel with 70% stenosis and evidence of myocardial ischemia (95% of patients) or at least 1 proximal vessel with 80% stenosis accompanied by classic angina without provocative testing. Patients with persistent class W angina, heart failure, recent revascularization, anatomy not suitable for PCI, or a markedly positive stress test result were excluded.
Intensive medical therapy consisted of aspirin or clopidogrel, metoprolol, amlodipine and/or isosorbide mononitrate, and lisinopril or losartan. Simvastatin (Zocor) with or without ezetimibe (Zetia) was used to achieve a target low-density lipoprotein cholesterol level of 40 mg/dL (1.03 mmol/L) and a triglyceride level of
