Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May;18(3):1-12.
doi: 10.48305/arya.2022.24252.

Medical therapy versus percutaneous coronary intervention or coronary artery bypass graft in stable coronary artery disease; a systematic review and meta-analysis of randomized clinical trials

Majid Davari  1 , Mende Mensa Sorato  2 , Behzad Fatemi  2 , Soheila Rezaei  3 , Hamid Sanei  4
Affiliations

Medical therapy versus percutaneous coronary intervention or coronary artery bypass graft in stable coronary artery disease; a systematic review and meta-analysis of randomized clinical trials

Majid Davari et al. ARYA Atheroscler. 2022 May.

Abstract

Background: Ischemic heart disease (IHD) is the first cause of mortality in the world. Stable coronary artery disease (CAD) is the most common IHD. Medical therapy (MT), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG) are three strategies for the management of this disease. The main aim of this study was the comparison of MT with PCI or CABG in terms of cardiovascular (CV) mortality, myocardial infarction (MI), unplanned revascularization (UR), stroke, and freedom from angina in managing stable CAD.

Methods: The Cochrane Central Register of Controlled Trials, Embase, PubMed, and Scopus were searched. Two reviewers independently appraised the titles and abstracted data of the identified studies. After the Full-text reviewing phase, eligible studies were analyzed through the random-effect meta-analysis method. Finally, a sensitivity analysis was conducted for the robustness of findings.

Results: Nine randomized controlled trials (RCTs) were included. The pooled RR of CV mortality associated with MT compared with PCI and CABG was 1.22 and 1.385, respectively. Overall, The RR of MT associated with MI, UR, stroke, and freedom from angina compared with PCI was 1.001, 1.151, 0.799, and 0.801, respectively.

Conclusion: Our results revealed no statistically significant difference between MT and PCI in terms of studied primary outcomes. The findings also highlighted that there is no statistically significant difference between MT and CABG in terms of CV mortality.

Keywords: Coronary Artery Disease; Medication Therapy Management; Meta-analysis; Myocardial infarction; Percutaneous coronary intervention; coronary artery bypass grafting.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of study selection MI: Myocardial Infarction; RCT: Randomized Clinical Trial; SIHD: Stable Ischemic Heart Disease
Figure 2
Figure 2
Pooled RR of CV mortality comparing MT with CABG CABG: Coronary artery bypass grafting; CASS: The coronary artery surgery study; CI: Confidence Interval; CV: Cardiovascular; MASS: Medicine, Angioplasty, or Surgery Study; MT: Medical Therapy; RR: Risk Ratio; MASS II: The Second Medicine, Angioplasty, or Surgery Study
Figure 3
Figure 3
Pooled Risk Ratio of A. Cardiovascular mortality and B. MI comparing MT with PCI ACME: Angioplasty compared to medicine; CABG: Coronary artery bypass grafting; CASS: The coronary artery surgery Study; COURAGE: Clinical Outcome Utilizing Revascularization and Aggressive Drug Evaluation; EUROCTO: Evaluate the Utilization of Revascularization or Optimal Medical Therapy for the Treatment of Chronic Total Coronary Occlusions; FAME2: Fractional Flow Reserve versus Angiography for Multi-vessel Evaluation 2; MASS II: The Second Medicine, Angioplasty, or Surgery Study; MASS: Medicine, Angioplasty, or Surgery Study; MT: medical therapy; PCI: Percutaneous coronary intervention; RITA-2: The Second Randomized Intervention Treatment of Angina; TIME: Trial of invasive versus medical therapy in elderly patients; RR: Risk Ratio
Figure 4
Figure 4
Pooled Risk Ratio of C. Unplanned revascularization, D. stroke, and E. Freedom from Angina comparing MT with PCI ACME: Angioplasty Compared to Medicine; CABG: Coronary artery bypass grafting; CASS: The coronary artery surgery Study; COURAGE: Clinical Outcome Utilizing Revascularization and Aggressive Drug Evaluation; EUROCTO: Evaluate the Utilization of Revascularization or Optimal Medical Therapy for the Treatment of Chronic Total Coronary Occlusions; FAME2: Fractional Flow Reserve versus Angiography for Multi-vessel Evaluation 2; MASS II: The Second Medicine, Angioplasty, or Surgery Study; MASS: Medicine, Angioplasty, or Surgery Study; MT: Medical therapy; PCI: Percutaneous coronary intervention; RITA-2: The Second Randomized Intervention Treatment of Angina; TIME: Trial of invasive versus medical therapy in elderly patients; RR: Risk Ratio; UR: Unplanned Revascularization
See this image and copyright information in PMC

References

    1. World Health Organization. Global Health Estimates 2016: Deaths by cause, age, sex, by country and by region, 2000-2016. Geneva, Switzerland: WHO; 2018.
    1. Bhatia SK. Biomaterials for clinical applications. New York, NY: Springer; 2010. pp. 1–21.
    1. Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res. 2014;114(12):1852–66. - PubMed
    1. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41(3):407–77. - PubMed
    1. Hurst JW, Walsh R, Fuster V, Fang J, O'Rourke RA. Hurst's the Heart Manual of Cardiology. 13th. New York, NY: McGraw-Hill Education; 2012.

LinkOut - more resources