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

被引:316
作者
Katritsis, DG
Ioannidis, JPA [1 ]
机构
[1] Univ Ioannina, Sch Med, Dept Hyg & Epidemiol, GR-45110 Ioannina, Greece
[2] Athens Euroclin, Dept Cardiol, Athens, Greece
[3] Fdn Res & Technol Hellas, Biomed Res Inst, Ioannina, Greece
[4] Tufts Univ, Sch Med, New England Med Ctr, Inst Clin Res & Hlth Policy Studies, Boston, MA 02111 USA
关键词
meta-analysis; angioplasty; myocardial infarction; mortality;
D O I
10.1161/CIRCULATIONAHA.104.521864
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
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.
引用
收藏
页码:2906 / 2912
页数:7
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