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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Effectiveness of Coronary Sinus Reducer for Treatment of Refractory Angina: A Meta-analysis
2022, Canadian Journal of CardiologyCitation Excerpt :Finally, although the primary outcome is based on CCS angina scores, these have not been validated as a research tool to quantify angina in clinical studies and were designed as clinical aids. However, use of CCS angina class is widespread in clinical trials assessing effect of various therapies on angina.26,31 In conclusion, this meta-analysis of clinical studies describing the outcomes of patients with refractory angina implanted with the Neovasc Reducer for CS narrowing demonstrates its safety and efficacy.
Revascularization versus medical therapy for the treatment of stable coronary artery disease: A meta-analysis of contemporary randomized controlled trials
2021, International Journal of CardiologyCitation Excerpt :PCI has commonly been used as the invasive treatment of choice in patients with stable CAD, but whether this approach is superior to MT in reducing the risk of death and MI in these patients is still unclear [10,12]. Several individual randomized controlled trials (RCTs) as well as their pooled analyses have consistently demonstrated no differences in the risk of major outcomes, such as death or MI, between PCI and MT. [13–16] A limitation of previous meta-analyses is the inclusion of RCTs that did not use contemporary pharmacologic therapies that have been shown to favorably affect prognosis, including aspirin, statins, and renin-angiotensin-aldosterone system inhibitors. Though the evidence suggests CABG might be more effective in comparison to PCI among patients with extensive and prognostically severe CAD, only a very few studies have evaluated the combination of PCI and CABG in comparison to MT in the treatment of stable CAD.
Impact of glycemic variability on the occurrence of periprocedural myocardial infarction and major adverse cardiovascular events (MACE) after coronary intervention in patients with stable angina pectoris at 6 months follow-up
2017, Clinica Chimica ActaCitation Excerpt :Patients enrolled in our study were usually with hypertension, diabetes, dyslipidemia, previous myocardial infarction, multivessel, CCS III or IV, so PCI was performed to provide a greater angina relief [21]. Although interventional treatment of stable angina pectoris would not improve prognosis compared with optimal medical therapy according to the previous study, and medical therapy is considered the most appropriate initial clinical management for patients with stable angina [3,4,22]. This study has several limitations.
Medical Therapy with Versus Without Revascularization in Stable Patients with Moderate and Severe Ischemia the Case for Community Equipoise
2016, Journal of the American College of CardiologyCitation Excerpt :In the BARI 2D study, greater freedom from angina with revascularization compared with intensive MT lasted beyond 1 year only in the CABG stratum (36). Finally, a report from 10 randomized trials of PCI versus MT in 6,762 patients with SIHD found no difference in angina relief between the 2 approaches at the end of study follow-up (RR: 1.10; 95% CI: 0.97 to 1.26) (40). The incremental benefit of PCI observed in older trials (OR: 3.38; 95% CI: 1.89 to 6.04) was substantially less or absent in recent trials (OR: 1.13; 95% CI: 0.76 to 1.68), possibly due to greater use of evidence-based therapies.
See editorial by Waters, pages 411-414 of this issue.
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