医学
传统PCI
经皮冠状动脉介入治疗
内科学
冠状动脉疾病
血运重建
心肌梗塞
心脏病学
随机对照试验
心绞痛
射血分数
心力衰竭
作者
Rahman Shah,Mannu Nayyar,Francis K. Le,Ajay Labroo,Abrar Nasr,Abdul Rashid,Donnie A. Davis,William S. Weintraub,William E. Boden
出处
期刊:Coronary Artery Disease
[Ovid Technologies (Wolters Kluwer)]
日期:2021-04-19
卷期号:33 (2): 91-97
被引量:3
标识
DOI:10.1097/mca.0000000000001041
摘要
Whether percutaneous coronary intervention (PCI) improves clinical outcomes in patients with chronic angina and stable coronary artery disease (CAD) has been a continuing area of investigation for more than two decades. The recently reported results of the International Study of Comparative Health Effectiveness with Medical and Invasive Approaches, the largest prospective trial of optimal medical therapy (OMT) with or without myocardial revascularization, provides a unique opportunity to determine whether there is an incremental benefit of revascularization in stable CAD patients.Scientific databases and websites were searched to find randomized clinical trials (RCTs). Pooled risk ratios were calculated using the random-effects model.Data from 10 RCTs comprising 12 125 patients showed that PCI, when added to OMT, were not associated with lower all-cause mortality (risk ratios, 0.96; 95% CI, 0.87-1.08), cardiovascular mortality (risk ratios, 0.91; 95% CI, 0.79-1.05) or myocardial infarction (MI) (risk ratios, 0.90; 95% CI, 0.78-1.04) as compared with OMT alone. However, OMT+PCI was associated with improved anginal symptoms and a lower risk for revascularization (risk ratios, 0.52; 95% CI, 0.37-0.75).In patient with chronic stable CAD (without left main disease or reduced ejection fraction), PCI in addition to OMT did not improve mortality or MI compared to OMT alone. However, this strategy is associated with a lower rate of revascularization and improved anginal symptoms.
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