FRSM
20.03.2009, 16:10
PCI doesn’t reduce mortality in people with chronic coronary artery disease
Lancet 2009;373:911-8[CrossRef][Medline]
After 20 years of research and innovation, medical treatment may still be the best option for many adults with non-acute coronary artery heart disease. In a meta-analysis of 61 trials, percutaneous coronary interventions (PCI) with bare metal or drug eluting stents did not save lives or prevent heart attacks compared with best medical treatment.
The authors used state of the art network meta-analysis to overcome a paucity of head to head trials comparing medical treatment with stents. The comparisons are necessarily indirect, but they still support a strategy of best medical treatment first for patients with non-acute coronary artery disease, they write. They analysed data from more than 25 000 adults. A substantial minority had unstable angina, but all of them were in trials comparing different stent types or comparing bare metal stents with traditional balloon angioplasty. Patients with acute myocardial infarction were excluded.
PCI may not prolong survival, but we have some evidence that it can relieve symptoms and improve quality of life, particularly when combined with best medical treatment, says a linked comment (p 870). We still need trials of PCI as an adjunct not an alternative to drugs for people with stable disease, and they must include measures of quality of life.
Lancet 2009;373:911-8[CrossRef][Medline]
After 20 years of research and innovation, medical treatment may still be the best option for many adults with non-acute coronary artery heart disease. In a meta-analysis of 61 trials, percutaneous coronary interventions (PCI) with bare metal or drug eluting stents did not save lives or prevent heart attacks compared with best medical treatment.
The authors used state of the art network meta-analysis to overcome a paucity of head to head trials comparing medical treatment with stents. The comparisons are necessarily indirect, but they still support a strategy of best medical treatment first for patients with non-acute coronary artery disease, they write. They analysed data from more than 25 000 adults. A substantial minority had unstable angina, but all of them were in trials comparing different stent types or comparing bare metal stents with traditional balloon angioplasty. Patients with acute myocardial infarction were excluded.
PCI may not prolong survival, but we have some evidence that it can relieve symptoms and improve quality of life, particularly when combined with best medical treatment, says a linked comment (p 870). We still need trials of PCI as an adjunct not an alternative to drugs for people with stable disease, and they must include measures of quality of life.