Study Compares PCI Strategies to Medical Therapy in Patients with Non-Acute CAD
In the United States, more than one million patients are treated with percutaneous coronary intervention (PCI), often for non-acute coronary artery disease (CAD). Over the past 20 years, percutaneous transluminal balloon coronary angioplasty (PTCA), bare metal stents (BMS), and drug-eluting stents (DES) succeeded each other as PCI treatment strategies for coronary artery disease. This study compared medical therapy (e.g., lifestyle modifications, medication) to these PCI strategies in the treatment of patients with non-acute CAD. Investigators reviewed 66 randomized clinical trials that included 26,438 patients, comparing different PCI strategies and medical therapy. Findings show that while BMS and DES yielded increased improvements in diminishing the need for revascularization, innovations in PCI technologies have not improved outcomes (i.e., incidence of myocardial infarction, mortality) compared to medical therapy. For example, there were no statistically significant differences in mortality among the PCI treatment strategies.
Trikalinos T, Alsheikh-Ali A, Tatsioni A, Nallamothu B, and Kent D. Percutaneous coronary interventions for non-acute coronary artery disease: A quantitative twenty-year synopsis. Lancet March 14, 2009;373(9667):911-18.
Dr. Nallamothu is part of HSR&D's Center for Clinical Management Research in Ann Arbor.