Current Atherosclerosis Reports

, Volume 2, Issue 4, pp 290–296 | Cite as

Percutaneous coronary intervention versus medical therapy for coronary heart disease

  • David J. Maron


Medical therapy reduces myocardial infarction and death in patients with stable coronary heart disease (CHD). In contrast, there is little evidence available to evaluate the impact of percutaneous coronary intervention (PCI) on hard endpoints in such patients. Four randomized, controlled trials have compared PCI with medical therapy. These studies have demonstrated that PCI results in an improvement in angina and exercise tolerance compared with medical therapy, but they also suggest that medical therapy may be preferable to PCI with respect to the risk of cardiac events. Interpretation of these studies has been limited by small sample size, exclusion of high-risk subjects, no or reduced use of stents, lack of a cost-effectiveness evaluation, and absence of risk factor intervention (except for Atorvastatin versus Revascularization Treatment [AVERT], which used aggressive low-density lipoprotein lowering with atorvastatin in the medical group only). The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial will permit better definition of the role of PCI in the treatment of stable or recently stabilized patients with CHD.


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References and Recommended Reading

  1. 1.
    American Heart Association: 2000 Heart and Stroke Statistical Update, Dallas, TX: American Heart Association, 1999.Google Scholar
  2. 2.
    Weaver WD, Simes RJ, Betriu A, et al.: Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA 1997, 278(23):2093–2098.PubMedCrossRefGoogle Scholar
  3. 3.
    Scandinavian Simvastatin Survival Study: Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study. Lancet 1994, 344:1383–1389.CrossRefGoogle Scholar
  4. 4.
    Sacks FM, Pfeffer MA, Moye LA, et al.: The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels: Cholesterol and Recurrent Events Trial investigators. N Engl J Med 1996, 335:1001–1009.PubMedCrossRefGoogle Scholar
  5. 5.
    Lipid Study Group: Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels: the Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. N Engl J Med 1998, 339:1349–1357.CrossRefGoogle Scholar
  6. 6.
    Yusuf S, Peto R, Lewis J, et al.: Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis 1985, 27:335–371.PubMedCrossRefGoogle Scholar
  7. 7.
    Lau J, Antman EM, Jimenez-Silva J, et al.: Cumulative meta-analysis of therapeutic trials for myocardial infarction. N Engl J Med 1992, 327:248–254.PubMedCrossRefGoogle Scholar
  8. 8.
    Pfeffer JM, Fischer TA, Pfeffer MA: Angiotensin-converting enzyme inhibition and ventricular remodeling after myocardial infarction. Ann Rev Physiol 1995, 57:805–826.CrossRefGoogle Scholar
  9. 9.
    Pfeffer MA, Braunwald E, Moye LA, et al.: Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial: the SAVE Investigators. N Engl J Med 1992, 327:669–677.PubMedCrossRefGoogle Scholar
  10. 10.
    Yusuf S, Pepine CJ, Garces C, et al.: Effect of enalapril on myocardial infarction and unstable angina in patients with low ejection fractions. Lancet 1992, 340:1173–1178.PubMedCrossRefGoogle Scholar
  11. 11.
    The Heart Outcomes Prevention Evaluation Study Investigators: Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med 2000, 342:145–153.CrossRefGoogle Scholar
  12. 12.
    Antiplatelet Trialists’ Collaboration: Collaborative overview of randomised trials of antiplatelet therapy: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients: antiplatelet trialists’ collaboration. Br Med J 1994, 308:81–106.Google Scholar
  13. 13.
    de Lorgeril M, Salen P, Martin JL, et al.: Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999, 99:779–785.PubMedGoogle Scholar
  14. 14.
    Oldridge NB, Guyatt GH, Fischer ME, et al.: Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA 1988, 260:945–950.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Connor GT, Buring JE, Yusuf S, et al.: An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989, 80:234–244.PubMedGoogle Scholar
  16. 16.
    Parisi AF, Folland ED, Hartigan PA: A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. N Engl J Med 1992, 326:10–16.PubMedCrossRefGoogle Scholar
  17. 17.
    Strauss WE, Fortin T, Hartigan P, et al.: A comparison of quality of life scores in patients with angina pectoris after angioplasty compared with after medical therapy: outcomes of a randomized clinical trial. Circulation 1995, 92:1710–1719.PubMedGoogle Scholar
  18. 18.
    Hartigan PM, Giacomini JC, folland ED, Parisi AF: Two-to three-year follow-up of patients with single-vessel coronary artery disease randomized to PTCA or medical therapy (results of a VA Cooperative Study). Am J Cardiol 1998, 82:1445–1450.PubMedCrossRefGoogle Scholar
  19. 19.
    RITA-2 Trial Participants: Coronary angioplasty versus medical therapy for angina: the second Randomised Intervention Treatment of Angina (RITA-2) trial. Lancet 1997, 350:461–468.CrossRefGoogle Scholar
  20. 20.
    Hueb WA, Bellotti G, de Oliveira SA, et al.: The Medicine, Angioplasty or Surgery Study (MASS): a prospective, randomized trial of medical therapy, balloon angioplasty or bypass surgery for single proximal left anterior descending artery stenoses. J Am Coll Cardiol 1995, 26:1600–1605.PubMedCrossRefGoogle Scholar
  21. 21.
    Hueb WA, Soares PR, Almeida De Oliveira S, et al.: Five-year follow-up of the medicine, angioplasty, or surgery study (MASS): a prospective, randomized trial of medical therapy, balloon angioplasty, or bypass surgery for single proximal left anterior descending coronary artery stenosis. Circulation 1999, 100:107–113.Google Scholar
  22. 22.
    Pitt B, Waters D, Brown WV, et al.: Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease: Atorvastatin versus Revascularization Treatment Investigators. N Engl J Med 1999, 341:70–76.PubMedCrossRefGoogle Scholar
  23. 23.
    Ryan TJ, Bauman WB, Kennedy JW, et al.: Guidelines for percutaneous transluminal coronary angioplasty: a report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Percutaneous Transluminal Coronary Angioplasty). J Am Coll Cardiol 1993, 22:2033–2053.CrossRefGoogle Scholar
  24. 24.
    Gibbons RJ, Chatterjee K, Daley J, et al.: ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J Am Coll Cardiol 1999, 33:2092–2197.PubMedCrossRefGoogle Scholar
  25. 25.
    Brown BG, Zhao X-Q, Sacco DE, Albers JJ: Lipid lowering and plaque regression: new insights into prevention of plaque disruption and clinical events in coronary disease. Circulation 1993, 87:1781–1791.PubMedGoogle Scholar
  26. 26.
    Libby P: Molecular bases of the acute coronary syndromes. Circulation 1995, 91:2844–2850.PubMedGoogle Scholar

Copyright information

© Current Science Inc 2000

Authors and Affiliations

  • David J. Maron
    • 1
  1. 1.Division of Cardiovascular MedicineVanderbilt University School of MedicineNashvilleUSA

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