A Professional & Personal Networking Site for all People related to Cardiology
Symptomatic CAD- when medical therapy alone is an alternative to PCI.
im making a presentation on the topic: "Symptomatic CAD- when medical therapy alone is an alternative to PCI." your comments and suggestions will be most useful. do you know of any editorials on the subject?
thanks
Views: 3
Replies to This Discussion
-
Permalink Reply by Cardiology Network Team on -
The COURAGE trial should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial health care savings. PCI has an established place in treating angina but is not superior to intensive medical therapy to prevent myocardial infarction and death in symptomatic or asymptomatic patients such as those in this study. Secondary prevention has proved its worth, with lipid-modulating therapy, lifestyle modification, and the use of aspirin, beta-blockers, and ACE inhibitors. Patients whose condition is clinically unstable, who have left main coronary artery disease, or in whom medical therapy has failed to control symptoms remain candidates for revascularization, but PCI should not play a major role as part of a secondary prevention strategy.
More at NEJM
-
Permalink Reply by Cardiology Network Team on
-
Optimal Medical Therapy with or without PCI for Stable Coronary Disease
Background
In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention
(PCI) with intensive pharmacologic therapy and lifestyle intervention
(optimal medical therapy) is superior to optimal medical therapy alone
in reducing the risk of cardiovascular events.Methods
We conducted a randomized trial involving 2287 patients who had objective evidence of myocardial ischemia and significant coronary artery disease
at 50 U.S. and Canadian centers. Between 1999 and 2004, we assigned 1149
patients to undergo PCI with optimal medical therapy (PCI group) and
1138 to receive optimal medical therapy alone (medical-therapy group).
The primary outcome was death from any cause and nonfatal myocardial
infarction during a follow-up period of 2.5 to 7.0 years (median, 4.6).Results
There were 211 primary events in the PCI group and 202 events in the medical-therapy group. The 4.6-year cumulative primary-event rates were
19.0% in the PCI group and 18.5% in the medical-therapy group (hazard
ratio for the PCI group, 1.05; 95% confidence interval [CI], 0.87 to
1.27; P=0.62). There were no significant differences between the PCI
group and the medical-therapy group in the composite of death,
myocardial infarction, and stroke (20.0% vs. 19.5%; hazard ratio, 1.05;
95% CI, 0.87 to 1.27; P=0.62); hospitalization for acute coronary
syndrome (12.4% vs. 11.8%; hazard ratio, 1.07; 95% CI, 0.84 to 1.37;
P=0.56); or myocardial infarction (13.2% vs. 12.3%; hazard ratio, 1.13;
95% CI, 0.89 to 1.43; P=0.33).Conclusions
As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or
other major cardiovascular events when added to optimal medical
therapy. (ClinicalTrials.gov number, NCT00007657.)
