Feature | December 11, 2013

Angioplasty May Not be Better Than Drug Therapy in Stable Disease

Study results in JAMA Internal Medicine led by Stony Brook cardiologists suggests reconsidering strategy of revascularization

stony brook JAMA cath lab clinical trial study pharmaceuticals angioplasty
December 11, 2013 — For patients with stable coronary artery disease (CAD) who are not experiencing a heart attack and an abnormal stress test, treatment of their narrowed arteries by the common procedure of angioplasty may not provide additional benefits compared to drug therapy alone. This finding results from a survey of more than 4,000 patients with myocardial ischemia led by cardiologists at Stony Brook University School of Medicine. The survey results are published in the online first edition of JAMA Internal Medicine.
 
In the research paper titled “Percutaneous Coronary Intervention Outcomes in Patients With Stable Obstructive Coronary Artery Disease and Myocardial Ischemia: A Collaborative Meta-analysis of Contemporary Randomized Clinical Trials,” David Brown, M.D., and Kathleen Stergiopoulos, M.D., Ph.D., professors in the Department of Medicine, Division of Cardiovascular Medicine, Stony Brook University School of Medicine, worked with colleagues internationally to design a data study that combined data from clinical trials performed between 1970 and 2012 of patients who had either percutaneous coronary intervention (PCI), or angioplasty, plus drug therapy, or drug therapy alone to treat their CAD. 
 
Each of the clinical studies within the analysis reported outcomes of death and nonfatal myocardial infarction reported. Additionally, to reflect contemporary medical and interventional practice, inclusion criteria required stent implantation in at least 50 percent of the PCI procedures and statin medications to lower cholesterol in at least 50 percent of patients in both the PCI and drug therapy alone groups. This led to a total of five clinical trials yielding 4,064 patients with myocardial ischemia diagnosed by exercise stress testing, nuclear or echocardiocraphic stress imaging or fractional flow reserve (FFR).
 
The researchers reviewed outcomes data up to five years post PCI or drug treatment alone. They analyzed all-cause death, non-fatal myocardial infarction, unplanned revascularization, and angina in the patients. 
 
The analysis showed all-cause death rates between the two groups was not significantly different — 6.5 percent for patients receiving PCI and drug therapy versus 7.3 percent for patients receiving drug therapy alone. There was little difference in the rates of nonfatal myocardial infarction (9.2 percent with PCI versus 7.6 percent drug therapy) and recurrent or persistent angina (20.3 percent versus 23.3). The rate of unplanned revascularization was slightly different but not statistically significant (18.3 percent versus 28.4 percent).
 
“If our findings are confirmed in ongoing trials, many of the more than 10 million stress tests performed annually and subsequent revascularizations may be unnecessary,” said Brown.
 
He cautioned that additional studies beyond data analyses of clinical trials are necessary to fully determine if practices with PCI in stable CAD patients needs to be re-evaluated, and if so, under what circumstances and in which patient populations.
 
For more information: www.jamanetwork.com

Related Content

breast cancer, herceptin chemotherapy drug, heart damage, monitoring, Journal of Clinical Oncology study
News | Cardiac Diagnostics| April 28, 2016
April 28, 2016 — Breast cancer patients undergoing treatment with trastuzumab-containing regimens should be monitored
Feature | Business| April 28, 2016 | Dave Fornell
 
Technology | Stents Peripheral| April 27, 2016
Veniti Inc. announced the first successful treatment with the Vici Verto Venous Stent System of a patient suffering...
coronary CT angiography, CCTA, SCOT-HEART trial substudy, SCCT
News | Computed Tomography (CT)| April 26, 2016
The results of a secondary analysis of the SCOT-HEART trial show that coronary computed tomography angiography (CCTA)...
sleep patterns, metabolic syndrome, risk factors, ACC study
News | Cardiac Diagnostics| April 26, 2016
Taking long naps or being excessively tired during the day is associated with a higher risk for developing metabolic...
Auris Surgical Robotics, acquisition, Hansen Medical
News | Robotic Systems| April 26, 2016
Auris Surgical Robotics Inc. and Hansen Medical Inc. announced that they have signed a definitive merger agreement...
CABG, bypass surgery, heart failure, NHLBI study
News | Cardiovascular Surgery| April 25, 2016
Scientists have found that a greater number of patients with coronary artery disease may benefit from coronary artery...
Siemens Sensis Vibe, hemodyanamics system

Siemens released the Sensis Vibe hemodyanamics system at ACC.16. The newer system offers better integration of cath lab data into cath lab reports and the electronic medical record (EMR).

Feature | ACC| April 25, 2016 | Jon Brubaker, MBA, RCVT, Tom Watson, BS, RCVT, and Sabrina Newell MS, RCS
There were several trends seen in new cardiovascular technologies showcased on the expo floor at the 2016 American...
Medtronic, Drug-Filled Stent, RevElution Trial results, ACC.16, CE Mark
News | Stents Drug Eluting| April 21, 2016
Medtronic plc announced new clinical data from one of the endpoints in the RevElution Trial for its novel, next-...
statins, heart disease, HOPE-3 trial, intermediate-risk patients, hypertension, ACC.16
News | Pharmaceuticals| April 20, 2016
Lowering cholesterol with statins significantly reduced adverse cardiovascular events in people with average...
Overlay Init