Optimal medical management vs. percutaneous coronary intervention for patients with stable angina: from nation-wide Korean Insurance data

Abstract

Abstract Background To investigate whether percutaneous coronary intervention (PCI) on top of optimal medical therapy (OMT) is superior to OMT only in patients with stable angina. Methods We enrolled patients with stable angina from 2005-2010 using the Korean national Insurance data. 68621 patients were candidate with stable angina and finally 5673 patients in PCI plus OMT and 5673 in OMT were selected with 1:1 propensity matching. Results Primary endpoint, a composite of myocardial infarction (MI), stroke, cardiac death and revascularization was significantly more common in PCI than in OMT group, 13.5/1000 vs. 11.5/1000 person year with HR, 1.182(1.059-1.319) (P=0.0027). Individual outcome rate of MI, revascularization and cardiac death was higher in PCI group then in OMT group , 2.9 vs. 2. (HR [1.376 1.085-1.744], p=0.0085), 30.3 vs. 8.1 (HR 3.638 [3.269-4.049], p<0.001) and 4.8 vs 3.4/1000 person year (HR 1.397 [1.155-1.69], p=0.0006) respectively. No difference was found in stroke rate. In subgroup analysis same trend of more rate of event in PCI group was detected. Conclusions PCI was associated with higher rate of primary endpoint of MI, stroke, cardiac death as compared to OMT only in patients with stable angina.Primary endpoint between PCI vs. OMT