Percutaneous Coronary Intervention Versus Medical Therapy in the Treatment of Stable Coronary Artery Disease: An Updated Meta-Analysis of Contemporary Randomized Controlled Trials.

Abstract

The net clinical benefit of percutaneous coronary intervention (PCI) compared with medical therapy (MT) alone for the treatment of stable coronary artery disease (CAD) remains uncertain. We conducted an updated meta-analysis of randomized controlled trials (RCTs) to compare PCI with MT for the treatment of patients with stable CAD. RCTs of PCI vs MT in patients with stable CAD were identified from MEDLINE, the Cochrane Library, and manual search of bibliographies to March 2020. Study-specific risk ratios (RRs) with 95% confidence intervals (CIs) were pooled for the composite of all-cause mortality, myocardial infarction (MI), revascularizations, rehospitalizations, or stroke and its individual components. Eleven unique RCTs comprising 9629 patients were included. PCI reduced the overall risk of the composite outcome of allcause mortality, MI, revascularizations, rehospitalizations, or stroke (RR, 0.63; 95% CI, 0.46-0.87); unplanned revascularization (RR, 0.58; 95% CI, 0.44-0.77); and fatal MI (RR, 0.69; 95% CI, 0.52-0.92). There were no significant differences in overall risk of all-cause mortality and other cardiovascular events comparing PCI with MT. The composite outcome of all-cause mortality, MI, revascularizations, rehospitalizations, or stroke was reduced with PCI at 2-5 years. In patients with stable CAD, overall, short-term and intermediate-term risks of all-cause mortality are not significantly different between PCI and MT. However, PCI may reduce the overall and intermediate-term risk of the combined outcome of all-cause mortality, MI, revascularizations, rehospitalizations, or stroke.