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Meta-Analysis
. 2024 Jul 4;24(1):335.
doi: 10.1186/s12872-024-03997-7.

An updated meta-analysis of optimal medical therapy with or without invasive therapy in patients with stable coronary artery disease

Lei Bi #  1 , Yu Geng #  1 , Yintang Wang #  1 , Siyuan Li  1 , Kuogen Sun  2 , Yiqi Guo  3 , Ou Zhang  4 , Ping Zhang  5
Affiliations
Meta-Analysis

An updated meta-analysis of optimal medical therapy with or without invasive therapy in patients with stable coronary artery disease

Lei Bi et al. BMC Cardiovasc Disord. .

Abstract

Background: The efficacy of optimal medical therapy (OMT) with or without revascularization therapy in patients with stable coronary artery disease (SCAD) remains controversial. We performed a meta-analysis of randomized controlled trials (RCTs) that compared OMT with or without revascularization therapy for SCAD patients.

Methods: Studies were searched in PubMed, EMBASE, and the Cochrane Central Register of Clinical Trials from January 1, 2005, to December 30, 2023. The main efficacy outcome was a composite of all-cause death, myocadiac infarction, revascularization, and cerebrovascular accident. Results were pooled using random effects model and fixed effects model and are presented as odd ratios (ORs) with 95% confidence intervals (CI).

Results: Ten studies involving 12,790 participants were included. The arm of OMT with revascularization compared with OMT alone was associated with decreased risks for MACCE (OR 0.55 [95% CI 0.38-0.80], I²=93%, P = 0.002), CV death (OR 0.84 [95% CI 0.73-0.97], I²=36%, P = 0.02), revascularization (OR 0.32 [95% CI 0.20-0.50], I²=92%, P < 0.001), and MI (OR 0.85 [95% CI 0.76-0.96], I²=45%, P = 0.007). While there was no significant difference between OMT with revascularization and OMT alone in the odds of all-cause death (OR 0.94 [95% CI 0.84-1.05], I²=0%, P = 0.30).

Conclusions: The current updated meta-analysis of 10 RCTs shows that in patients with SCAD, OMT with revascularization would reduce the risk for MACCE, cardiovascular death, and MI. However, the invasive strategy does not decrease the risks for all-cause mortality when comparing with OMT alone.

Keywords: CABG; Optimal medical therapy; PCI; Stable coronary artery disease.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of search and study selection process
Fig. 2
Fig. 2
Forest plot of pooled odds ratio (OR) comparing OMT with revascularization versus OMT alone for the efficacy outcomes. A: MACCE; B: all-cause death; C: CV death; D: revascularization; E: MI; F: hospitalizations; G: cerebrovascular accident
See this image and copyright information in PMC

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