Stenting or Medical Therapy for Stable CAD: A Game Changer?

A new meta-analysis convincingly supports optimal medical therapy as an initial approach.

The benefits of percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) are well established, but the procedure's effectiveness for stable coronary artery disease (CAD) has long been questioned. Trials have consistently failed to show that PCI reduces the risk for MI or death compared with an initial strategy of optimal medical therapy (OMT). Previous meta-analyses have been limited by the “moving targets” of evolving approaches to PCI and OMT, and by the conflation of stable CAD with acute coronary syndromes. Now, investigators have conducted a meta-analysis of trials comparing contemporary medical therapy and stent-era PCI in patients with stable ischemic heart disease.

Included were eight trials involving 7229 patien…

Reviewing Author

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)

Frederick A. Masoudi, MD, MSPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardBristol Myers Squibb; CPC Clinical Research

Grant/Research SupportNational Heart, Lung, and Blood Institute

Editorial BoardsUpToDate; American College of Cardiology Self-Assessment Program (SAP)

Leadership Positions in Professional SocietiesAmerican College of Cardiology (Chair, Innovations Committee)