Optimal medical therapy with or without PCI for stable coronary disease.

@article{Boden2007OptimalMT,
  title={Optimal medical therapy with or without PCI for stable coronary disease.},
  author={William E. Boden and Robert A. O'rourke and Koon K Teo and Pamela M. Hartigan and David J. Maron and William J. Kostuk and Merril L. Knudtson and Marcin Dada and Paul Casperson and Crystal L. Harris and Bernard R. Chaitman and Leslee J. Shaw and Gilbert Gosselin and Shah Nawaz and Lawrence M. Title and Gerald T. Gau and Alvin S. Blaustein and David C. Booth and Eric R. Bates and John A. Spertus and Daniel S. Berman and G. B. John Mancini and William S. Weintraub},
  journal={The New England journal of medicine},
  year={2007},
  volume={356 15},
  pages={
          1503-16
        }
}
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… 

Figures and Tables from this paper

Medical Versus Revascularization Therapy in the Management of Stable Angina Pectoris
TLDR
In patients with disabling stable angina pectoris without high-risk criteria, the percutaneous coronary intervention using drug-eluting stents can be a viable alternative to surgical revascularization in reducing the risk of cardiovascular events.
Initial Invasive or Conservative Strategy for Stable Coronary Disease.
TLDR
Evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years is not found.
Management of Coronary Disease in Patients with Advanced Kidney Disease.
TLDR
Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, it was found that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction.
Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials
TLDR
In this most rigorous and comprehensive analysis in patients with stable coronary artery disease, PCI did not reduce the risk of mortality, cardiovascular death, nonfatal myocardial infarction, or revascularization, and PCI provided a greater angina relief compared with OMT alone, larger studies with sufficient power are required to prove this conclusively.
Recent Changes in Practice of Elective Percutaneous Coronary Intervention for Stable Angina
Background— The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial was designed to compare optimal medical therapy alone versus optimal medical therapy and
Stable and also unstable coronary disease – COURAGE and the importance of optimal medical therapy
  • G. Jackson
  • Medicine
    International journal of clinical practice
  • 2007
TLDR
It is reassuring to know that an initial medical approach did not lead to an excess of acute events and once more this suggests the pivotal role of statin therapy stabilising plaque.
Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease.
TLDR
In patients with stable coronary artery disease and functionally significant stenoses, FFR-guided PCI plus the best available medical therapy, as compared with the best Available medical therapy alone, decreased the need for urgent revascularization.
...
...

References

SHOWING 1-10 OF 74 REFERENCES
Coronary intervention for persistent occlusion after myocardial infarction.
TLDR
PCI did not reduce the occurrence of death, reinFarction, or heart failure, and there was a trend toward excess reinfarction during 4 years of follow-up in stable patients with occlusion of the infarct-related artery 3 to 28 days after myocardial infarction.
Percutaneous Coronary Intervention Versus Conservative Therapy in Nonacute Coronary Artery Disease: A Meta-Analysis
TLDR
In patients with chronic stable CAD, PCI does not offer any benefit in terms of death, myocardial infarction, or the need for subsequent revascularization compared with conservative medical treatment.
A comparison of angioplasty with medical therapy in the treatment of single-vessel coronary artery disease. Veterans Affairs ACME Investigators.
TLDR
For patients with single-vessel coronary artery disease, PTCA offers earlier and more complete relief of angina than medical therapy and is associated with better performance on the exercise test.
Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. Atorvastatin versus Revascularization Treatment Investigators.
TLDR
In low-risk patients with stable coronary artery disease, aggressive lipid-lowering therapy is at least as effective as angioplasty and usual care in reducing the incidence of ischemic events.
Early invasive versus selectively invasive management for acute coronary syndromes.
TLDR
It could not demonstrate that, given optimized medical therapy, an early invasive strategy was superior to a selectively invasive strategy in patients with acute coronary syndromes without ST-segment elevation and with an elevated cardiac troponin T level.
...
...