Association of PCI with outcomes in stable coronary artery disease

Abstract Background The utility of percutaneous coronary intervention (PCI) in patients with stable symptomatic coronary artery disease (CAD) remains unclear. Although there has been recent literature to suggest that PCI may improve anginal symptoms, studies evaluating the association of PCI with clinical outcomes compared to optimal medical therapy (OMT) has yielded conflicting results. Purpose We performed a systematic review and meta-analysis evaluating the association of PCI compared to OMT with adverse cardiovascular outcomes in patients with stable CAD. Methods A literature search was performed using the databases Ovid MEDLINE, Embase, and Web of Science, identifying studies that evaluated the association of PCI with clinical endpoints in patients with symptomatic stable CAD. The primary endpoint was all-cause mortality. Secondary endpoints were recurrent acute myocardial infarction (AMI), cerebrovascular accident (CVA), and unplanned coronary revascularization. The search was not restricted to time or publication status. Results A total of 17 studies with 20,389 patients (11,294 PCI, 9095 OMT) met inclusion criteria. Mean follow-up duration was 3.98 years (ranging from 1 year to 6.5 years), mean age was 63.8, mean ejection fraction was 59%. All patients had symptomatic CAD with lesion severity >50%. Compared to OMT, PCI was associated with lower risk of mortality on short-term (≤1 year) but not long-term (>1 year) follow-up (OR 0.5, 95% CI 0.29-0.86; p=0.01; OR 0.68; 95% CI 0.42-1.12; p=0.88). PCI was not associated with lower risk of AMI or need for unplanned coronary revascularization (OR 1.02; 95% CI 0.73-1.44; p=0.90; OR 0.87; 95% CI 0.51-1.49; p=0.61). There was a trend toward lower risk of CVA in patients treated with OMT compared to PCI, however this was not statistically significant (OR 1.46; 95% CI 0.96-2.22; p=0.07). Conclusions The use of PCI in patients with stable CAD is associated with lower risk of all-cause mortality on short-term follow-up, however this association was not seen on long-term follow-up >1 year. PCI was not associated with lower risk of AMI or unplanned revascularization and may be associated with increased risk of CVA compared to OMT. Additional high-quality studies are needed to further associate the utility of PCI in this patient population.Figure 1Figure 2