Angioplasty may not offer added benefits

If a new study's findings are confirmed in ongoing trials, David Brown says, "many of the more than 10 million stress tests performed annually and subsequent revascularizations may be unnecessary." (Credit: Denise Chan/Flickr)

For patients with stable coronary artery disease (CAD) who are not experiencing a heart attack and an abnormal stress test, angioplasty may not offer more benefits than drug therapy alone.

For a new study, researchers surveyed more than 4,000 patients with myocardial ischemia, or inadequate circulation. The study combined data from clinical trials performed between 1970 and 2012 of patients who had either percutaneous coronary intervention (PCI), or angioplasty, plus drug therapy, or drug therapy alone to treat their CAD.

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Each of the clinical studies within the analysis reported outcomes of death and nonfatal myocardial infarction. Additionally, to reflect contemporary medical and interventional practice, inclusion criteria required stent implantation in at least 50 percent of the PCI procedures and statin medications to lower cholesterol in at least 50 percent of patients in both the PCI and drug therapy alone groups.

This led to a total of five clinical trials yielding 4,064 patients with myocardial ischemia diagnosed by exercise stress testing, nuclear or echocardiocraphic stress imaging, or fractional flow reserve.

The researchers reviewed outcome data up to five years post PCI or drug treatment alone. They analyzed all-cause death, non-fatal myocardial infarction, unplanned revascularization, and angina in the patients.

Published in JAMA Internal Medicine, the analysis showed all-cause death rates between the two groups was not significantly different—6.5 percent for patients receiving PCI and drug therapy versus 7.3 percent for patients receiving drug therapy alone.

Little difference

There was little difference in the rates of non-fatal myocardial infarction (9.2 percent with PCI vs. 7.6 percent drug therapy) and recurrent or persistent angina (20.3 percent vs. 23.3). The rate of unplanned revascularization was slightly different but not statistically significant (18.3 percent vs. 28.4 percent).

“If our findings are confirmed in ongoing trials, many of the more than 10 million stress tests performed annually and subsequent revascularizations may be unnecessary,” says David Brown, professor of medicine in the division of cardiovascular medicine at Stony Brook University.

Brown cautions that additional studies beyond data analyses of clinical trials are necessary to fully determine if practices with PCI in stable CAD patients needs to be re-evaluated, and if so, under what circumstances and in which patient populations.

Source: Stony Brook University