Medical Treatment, Percutaneous Coronary Intervention, or Coronary Artery Bypass Grafting for Stable CAD?

In meta-analyses of mortality and morbidity outcomes, CABG was better than PCI for multivessel disease, and PCI was not better than medical therapy in patients with ischemia.

Randomized trials of contemporary treatments for stable coronary artery disease (CAD) have been underpowered for hard endpoints such as mortality and myocardial infarction (MI). To derive statistically meaningful comparisons of these outcomes, two teams of investigators conducted meta-analyses of trial data.

Stergiopoulos and colleagues examined five randomized trials comparing percutaneous coronary intervention (PCI) and medical therapy with medical therapy alone in 4064 patients with stable CAD and documented ischemia. More than 90% of the patients were from three large trials (COURAGE, BARI 2D, and FAME 2). Follow-up duration was 5 years in four trials and 7 months in one (FAME 2). Use of drug-eluting stents varied from none to 95%, and d…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)