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Prognostischer Wert einer perkutanen Koronarintervention bei Patienten mit stabiler Angina pectoris

Schlussfolgerungen einer Metaanalyse von 17 randomisierten Studien unter Einschluss von COURAGE

Prognostic value of a percutaneous coronary intervention in patients with stable angina pectoris

Conclusions from a meta-analysis of 17 randomized studies including COURAGE

  • Interventionelle Kardiologie
  • Published:
Der Kardiologe Aims and scope

Zusammenfassung

Die Behandlung der stabilen Angina pectoris umfasst medikamentöse wie revaskularisierende Maßnahmen. Eine Revaskularisation kann mittels perkutaner Koronarintervention (PCI) oder Bypassoperation erfolgen. Bei allen Therapiemaßnahmen wird sowohl eine Behandlung der Beschwerden als auch eine Verbesserung der Prognose angestrebt. Während die Effektivität einer PCI zur Behandlung der Beschwerden unbestritten ist, wurde die Effektivität einer PCI zur Verbesserung der Prognose der Patienten kontrovers diskutiert. Allerdings war keine der bisher randomisiert durchgeführten Einzelstudien aufgrund der fehlenden „Power“ geeignet, den Effekt einer PCI auf das Überleben der Patienten mit stabiler Angina pectoris zu evaluieren. Die hier vorgestellte Metaanalyse fasst nun alle randomisiert durchgeführten Studien zusammen und berechnet die Effektivität einer PCI auf das Langzeitüberleben der Patienten im Vergleich zur medikamentösen Therapie. Dabei konnte gezeigt werden, dass bei einer mittleren Beobachtungsdauer von 51 Monaten in allen Studien zusammengenommen die Gesamtsterblichkeit im Vergleich zur rein medikamentösen Therapie signifikant um 20% gesenkt werden konnte.

Abstract

Treatment options for patients with stable coronary artery disease are based on medical drugs and revascularization procedures. Revascularization in patients with coronary artery disease can be performed by bypass surgery or percutaneous coronary intervention (PCI). The aim of both medical drugs and revascularization procedures is to relieve symptoms and to improve survival. While the impact of PCI on the reduction of symptoms in patients with stable angina pectoris is well established, its effects on the prognosis of these patients are still not defined. None of the randomized studies performed in comparison to medical treatment alone was able to assess the effect of a PCI on mortality. We therefore performed a meta-analysis of 17 randomized trials comparing a PCI-based invasive strategy with medical treatment alone for all-cause death. After an average follow-up period of 51 months in these trials, patients with a PCI-based invasive strategy had a 20% significant reduction in all-cause mortality compared to medical treatment alone.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: Herr Prof. Seyfarth gibt an, Vortragshonorare der Firmen Bristol-Myers Squibb, Lilly, Sanofi-Aventis erhalten zu haben. Herr Prof. Kastrati gibt an, Vortragshonorare der Firmen Bristol-Myers Squibb, Cordis, GlaxoSmithKline, Lilly, Medtronic, Novartis, Sanofi-Aventis erhalten zu haben. Herr Prof. Schömig gibt an, finanzielle Forschungsmittel der folgenden Institutionen und Firmen erhalten zu haben: TU München, Bayerische Forschungsstiftung, Amersham/General Electric, Bristol-Myers Squibb, Cordis, Cryocath, Guidant, Medtronic, Nycomed, Schering.

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  1. Deutsches Herzzentrum München, Klinik an der Technischen Universität München, Lazarettstraße 36, 80636, München, Deutschland

    M. Seyfarth, A. de Waha, J. Mehilli, J. Pache, A. Kastrati & A. Schömig

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  1. M. Seyfarth
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  2. A. de Waha
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  3. J. Mehilli
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  4. J. Pache
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  5. A. Kastrati
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  6. A. Schömig
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Correspondence to M. Seyfarth.

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Seyfarth, M., de Waha, A., Mehilli, J. et al. Prognostischer Wert einer perkutanen Koronarintervention bei Patienten mit stabiler Angina pectoris. Kardiologe 2, 479–487 (2008). https://doi.org/10.1007/s12181-008-0129-2

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