Percutaneous coronary intervention versus medical therapy for coronary heart disease
- 30 Downloads
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.
Unable to display preview. Download preview PDF.
References and Recommended Reading
- 1.American Heart Association: 2000 Heart and Stroke Statistical Update, Dallas, TX: American Heart Association, 1999.Google Scholar
- 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
- 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
- 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
- 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.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
- 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.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