Similar 5-year clinical outcomes in patients with stable coronary artery disease and myocardial ischaemia managed with an initial approach of medical therapy compared with medical therapy plus percutaneous coronary intervention

Commentary on: Stergiopoulos K, Boden WE, Hartigan P, et al. Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischaemia: a collaborative meta-analysis of contemporary randomized clinical trials. JAMA Intern Med 2014;174:232–40.[OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] In patients with stable coronary artery disease (CAD), the presence of myocardial ischaemia is associated with increased cardiac event rates. Percutaneous coronary intervention (PCI) achieves greater short-term reductions in myocardial ischaemia and angina than medical therapy. In contrast to patients with acute coronary syndromes, however, PCI has not been shown to reduce the likelihood of myocardial infarction (MI) or death in stable patients. The aim of this meta-analysis was to clarify the effect of PCI on clinical outcomes when restricted to patients who have demonstrable myocardial ischaemia. This was a meta-analysis of randomised controlled trials (RCTs) published between 1970 and November 2012 which compared medical therapy plus PCI with medical therapy alone in stable patients who had evidence of myocardial ischaemia. Included trials required stent use in at least 50% of patients … [1]: {openurl}?query=rft.jtitle%253DJAMA%2BIntern%2BMed%26rft.volume%253D174%26rft.spage%253D232%26rft_id%253Dinfo%253Adoi%252F10.1001%252Fjamainternmed.2013.12855%26rft_id%253Dinfo%253Apmid%252F24296791%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1001/jamainternmed.2013.12855&link_type=DOI [3]: /lookup/external-ref?access_num=24296791&link_type=MED&atom=%2Febmed%2F19%2F5%2F171.atom [4]: /lookup/external-ref?access_num=000333049200017&link_type=ISI