安定労作性狭心症に対する経皮的冠動脈形成術の効果

Objective: It remains unclear whether aggressive percutaneous coronary intervention (PCI) strategies are superior to medical therapy alone in reducing the risk of cardiovascular events among patients with stable angina. We aimed to elucidate the effect of PCI on subsequent cardiac events in patients with angiographically documented stable effort angina. Subjects: In all, 2,825 patients with stable coronary artery disease were registered and followed prospectively, and 776 patients with effort angina matched by propensity scores were analyzed. Coronary stenosis was angiographically documented in all patients. Results: During a mean follow-up period of 4.2 years, there was no difference in the cumulative total death between the PCI group and medical therapy group (5.2 vs 7.0%, respectively, p=0.292). Revascularization including re-PCI and bypass surgery was required more frequently in the PCI group than the medical therapy group (17.8 vs 11.6%, respectively, p<0.015). However, the composite outcome of cardiovascular death and non-fatal myocardial infarctions was significantly lower in the PCI group than the medical treatment group (3.6 vs 7.2%, respectively, p<0.026). Conclusions: Although PCI did not reduce total deaths and increased the frequency of revascularization, PCI in conjunction with medical therapy was associated with a reduction in subsequent myocardial infarctions and cardiovascular death.