Percutaneous Coronary Intervention Is Not Superior to Optimal Medical Therapy in Chronic Coronary Syndrome: A Meta-Analysis

Abstract

(1) Background and Aim: Conflicting evidence exists regarding the benefits of percutaneous coronary intervention (PCI) on survival and symptomatic relief of patients with chronic coronary syndrome (CCS) compared with optimal medical therapy (OMT). This meta-analysis is to evaluate the short- and long-term clinical benefit of PCI over and above OMT in CCS. (2) Methods: Main endpoints were major adverse cardiac events (MACEs), all-cause mortality, cardiovascular (CV) mortality, myocardial infarction (MI), urgent revascularization, stroke hospitalization, and quality of life (QoL). Clinical endpoints at very short (≤3 months), short- (<12 months), and long-term (≥ 12 months) follow-up were evaluated. (3) Results: Fifteen RCTs with a total of 16,443 patients with CCS (PCI n = 8307 and OMT n = 8136) were included in the meta-analysis. At mean follow-up of 27.7 months, the PCI group had similar risk of MACE (18.2 vs. 19.2 %; p < 0.32), all-cause mortality (7.09 vs. 7.88%; p = 0.56), CV mortality (8.74 vs. 9.87%; p = 0.30), MI (7.69 vs. 8.29%; p = 0.32), revascularization (11.2 vs. 18.3%; p = 0.08), stroke (2.18 vs. 1.41%; p = 0.10), and hospitalization for anginal symptoms (13.5 vs. 13.9%; p = 0.69) compared with OMT. These results were similar at short- and long-term follow-up. At the very short-term follow-up, PCI patients had greater improvement in the QoL including physical limitation, angina frequency, stability, and treatment satisfaction (p < 0.05 for all) but such benefits disappeared at the long-term follow-up. (4) Conclusions: PCI treatment of CCS does not provide any long-term clinical benefit compared with OMT. These results should have significant clinical implications in optimizing patient’s selection for PCI treatment.

Treatment Strategies for Chronic Coronary Heart Disease with Left Ventricular Systolic Dysfunction or Preserved Ejection Fraction—A Systematic Review and Meta-Analysis

“…Similar findings have been previously reported, as evidenced by the meta-analysis conducted by Bytyci, I. (2023), which indicated that revascularization does not diminish the risk of all-cause and CV mortality, MI, stroke, or hospitalization for angina progression when compared with OMT [29].…”

Exercise-based cardiac rehabilitation in stable angina pectoris: a narrative review on current evidence and underlying physiological mechanisms

“…Furthermore, a meta-analysis of 14 trials also showed no difference in all-cause mortality and cardiovascular mortality between revascularisation or optimal medical therapy alone after a median follow-up of 4.5 years [ 4 ]. Although this meta-analysis found more freedom of angina in favour of revascularisation, a more recent meta-analysis showed no difference between groups after 12-months of follow-up [ 5 ]. Finally, the ORBITA trial, the only double-blind study comparing PCI versus a sham procedure in SAP, showed no difference in symptoms and exercise capacity in 200 patients after a 6-week follow-up [ 3 ].…”

“…Approximately 35% of all (~40,000) PCIs in the Netherlands are performed in patients with stable coronary artery disease [ 1 ]. Although revascularisation can result in rapid symptom relief [ 2 ], long-term prognostic advantages seem limited [ 2 – 5 ] and are increasingly debated. A recent randomised controlled trial (RCT) compared revascularisation with optimal medical therapy in 5179 SAP patients with myocardial ischaemia, and found no between-group differences in mortality or major adverse cardiovascular events (MACE) after a median 3.2-year follow-up [ 2 ].…”