An updated meta-analysis of optimal medical therapy with or without invasive therapy in patients with stable coronary artery disease

Abstract Background The efficacy of optimal medical therapy (OMT) with or without revascularization therapy in patients with stable coronary artery disease (SCAD) remains controversial. We performed a meta-analysis of randomized controlled trials (RCTs) that compared OMT with or without revascularization therapy for SCAD patients. Methods Studies were searched in PubMed, EMBASE, and the Cochrane Central Register of Clinical Trials from January 1, 2005, to December 30, 2023. The main efficacy outcome was a composite of all-cause death, myocadiac infarction, revascularization, and cerebrovascular accident. Results were pooled using random effects model and fixed effects model and are presented as odd ratios (ORs) with 95% confidence intervals (CI). Results Ten studies involving 12,790 participants were included. The arm of OMT with revascularization compared with OMT alone was associated with decreased risks for MACCE (OR 0.55 [95% CI 0.38–0.80], I²=93%, P = 0.002), CV death (OR 0.84 [95% CI 0.73–0.97], I²=36%, P = 0.02), revascularization (OR 0.32 [95% CI 0.20–0.50], I²=92%, P