Role of percutaneous coronary intervention in the modern-day management of chronic coronary syndrome

Abstract

Contemporary randomised trials of percutaneous coronary intervention (PCI) in chronic coronary syndrome (CCS) demonstrate no difference between patients treated with a conservative or invasive strategy with respect to all-cause mortality or myocardial infarction, although trials lack power to test for individual endpoints and long-term follow-up data are needed. Open-label trials consistently show greater improvement in symptoms and quality of life among patients with stable angina treated with PCI. Further studies are awaited to clarify this finding. In patients with severe left ventricular (LV) systolic dysfunction and obstructive coronary artery disease in the Revascularization for Ischemic Ventricular Dysfunction trial, PCI has not been found to improve all-cause mortality, heart failure hospitalisation or recovery of LV function when compared with medical therapy. PCI was, however, performed without additional hazard and so remains a treatment option when there are favourable patient characteristics. The majority of patients reported no angina, and the low burden of angina in many of the randomised PCI trials is a widely cited limitation. Despite contentious evidence, elective PCI for CCS continues to play a significant role in UK clinical practice. While PCI for urgent indications has more than doubled since 2006, the rate of elective PCI remains unchanged. PCI remains an important strategy when symptoms are not well controlled, and we should maximise its value with appropriate patient selection. In this review, we provide a framework to assist in critical interpretation of findings from most recent trials and meta-analysis evidence.

Stem Cell Therapy against Ischemic Heart Disease

“…Current therapeutic strategies for acute and chronic coronary syndromes include coronary revascularization with percutaneous coronary intervention (PCI) [36] or coronary artery bypass grafting [8], as well as medical treatments comprising antiplatelet therapy with additional secondary prevention measures such as intensive lipid-lowering therapy, neurohormonal agents, and a modification of lifestyle [1,35,37]. Nevertheless, despite being the gold standard, PCI was unable to improve all-cause mortality, hospitalization for heart failure, or the restoration of left ventricular function compared to medical treatment in the Revascularization for Ischemic Ventricular Dysfunction trial, which was a large-scale clinical trial recruiting up to 700 patients across 40 centers in the UK [38].…”

“…Nevertheless, despite being the gold standard, PCI was unable to improve all-cause mortality, hospitalization for heart failure, or the restoration of left ventricular function compared to medical treatment in the Revascularization for Ischemic Ventricular Dysfunction trial, which was a large-scale clinical trial recruiting up to 700 patients across 40 centers in the UK [38]. A review of the overall evidence also showed PCI's lack of treatment advantage over conservative approaches in terms of all-cause mortality or myocardial infarction, unlike acute coronary syndrome [36].…”

Antithrombotic therapy at discharge and prognosis in patients with chronic coronary syndrome and atrial fibrillation who underwent PCI: a real-world study

“…Chronic coronary syndrome (CCS) is a manifestation of CAD, often occurring concurrently with AF [ 2 ]. It may require percutaneous coronary intervention (PCI) to improve anginal symptoms or reduce the risk of subsequent myocardial infarction and death [ 3 ]. Regarding AF, anticoagulant therapy is crucial for reducing adverse outcome [ 4 ].…”