Systematic review/meta-analysisA Meta-analysis of Randomized Controlled Trials Comparing Percutaneous Coronary Intervention With Medical Therapy in Stable Angina Pectoris
Section snippets
Protocol
The protocol for trial identification, inclusion and data abstraction was specified a priori and is available upon request. All reviewers were mandated to follow this protocol, and we calculated agreement statistics for the trials included among the reports screened in this systematic review.
Eligibility criteria
We included only randomized controlled trials (RCTs) that assessed the effects of PCI (ie, balloon angioplasty alone, bare metal stent implantation, or drug-eluting stent implantation) compared with medical
Included trials
Figure 1 summarizes our search strategy. Our trial identification strategies identified 1123 citations. The screening process identified 17 citations that advanced to full text review. A total of 10 trials fulfilled eligibility criteria and were included in this systematic review. Overall eligibility agreement was excellent (κ = 0.91). One eligible trial was published in 2 separate reports; Angioplasty Compared to Medicine Evaluation (ACME)-1 and ACME-2 refers to trials that analyzed patients
Discussion
The principal finding of our meta-analysis of RCTs comparing PCI with medical therapy was that there was no significant difference in all-cause mortality, CV mortality, or MI between the 2 assigned initial management strategies. While clearly there was methodologic variability among trials because of the evolution of PCI over the long time horizon during which these trials were conducted and reported, it is noteworthy that the earlier trials performed in the early 1990s (ACME7, 8) and late
Conclusions
In summary, this meta-analysis has shown that there is no difference with respect to all-cause mortality, CV mortality, or the incidence of MI with an initial management strategy of medical therapy alone as compared with PCI plus medical therapy. Our findings also suggest that either strategy is equivalent with respect to angina relief at the end of follow-up, although the confidence of this finding is less certain. Our results continue to reinforce existing clinical practice guidelines that
Disclosures
The authors have no conflicts of interest to disclose.
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