Does Percutaneous Coronary Intervention Reduce Mortality in Patients With Stable Chronic Angina Are We Talking About Apples and Oranges?

A fundamental principal of meta-analyses is that the same research question on a similar patient population is being addressed in all the enrolled studies. On the basis of our review of the identified studies, we concluded that the divergent findings on the potential mortality benefit of PCI in patients with stable angina are likely due to differences in characteristics of the patients enrolled in the studies. Among patients with chronic stable angina that is not immediately after myocardial infarction, the totality of evidence still favors the conclusion that PCI does not reduce mortality. In fact, whether PCI improves quality of life among patients with stable coronary angina is being questioned, as emerging data from a substudy of the COURAGE trial suggest PCI is associated with only a modest improvement in quality of life, which actually dissipated over time.14 Once again, clinicians are being challenged to understand why a divergence exists between recent evidence and the conventional wisdom that PCI is associated with a large benefit in symptom relief. Is it due to greater success in optimizing medical therapy, or is it due to a fundamental change in the type of patients who undergo PCI in current practice? Are there any demographic, clinical, or procedural characteristics that will ensure undergoing a PCI will improve a patient's quality of life and other outcomes? Rather than perseverating over the question of whether PCI improves mortality, an understanding of these differences may aid in the appropriate use of interventional PCI practice, especially in light of rapidly escalating healthcare costs. © 2009 American Heart Association, Inc.