|Control||Optimal medical therapy|
|Inclusion criteria||Stable CAD or Canadian Cardiovascular Society (CCS) class IV angina subsequently stabilized medically
Stenosis of at least 70% in at least one proximal coronary artery
Objective evidence of myocardial ischaemia (substantial changes in ST-segment depression or T-wave inversion on the resting electrocardiogram or inducible ischemia with either exercise or pharmacologic vasodilator stress) or at least one coronary stenosis of at least 80% and classic angina without provocative testing.
|Exclusion criteria||Persistent CCS class IV angina
Markedly positive stress test (substantial ST-segment depression or hypotensive response during stage 1 of the Bruce protocol)
Refractory heart failure or cardiogenic shock
An ejection fraction of less than 30%
Revascularization within the previous 6 months
Coronary anatomy not suitable for PCI.
|Follow-up||Median 4.6 years|
|Primary endpoint||Composite of death from any cause and nonfatal myocardial infarction|
|Secondary endpoint(s)||Composite of death, myocardial infarction, and stroke
Hospitalization for unstable angina with negative biomarkers
|Details||For OMT, all patients received aspirin (81â€“325 mg/day) or clopidogrel (75 mg/day). All patients received simvastatin alone or in combination with ezetimibe to reduce LDL-cholesterol levels (target of 1.55â€“2.220 mmol/L).
Exercise, fibrates and/or extended release niacin were used to raise HDL-cholesterol levels (target 1.03 mmol/L) and to reduce triglyceride levels (target of 1.69 mmol/L).
Both groups received anti-ischemic therapy (metoprolol, amlodipine and/or isosorbide mononitrate) with lisinopril or losartan.
|Brief summary:||PCI w/ bare-metal stents in stable CAD non-superior to medical therapy|
|PAPER: Optimal medical therapy with or without PCI for stable coronary disease.|
|Date||12 Apr 2007|
|Journal||N Engl J Med. 2007 Apr 12;356(15):1503-16.|
|Information||PCI (with BMS) vs. medical therapy in stable CAD
-No difference in composite of all-cause mortality and non-fatal MI
-No difference in ACS hospitalisation
|PAPER: Effect of PCI on quality of life in patients with stable coronary disease.|
|Date||14 Aug 2008|
|Journal||N Engl J Med. 2008 Aug 14;359(7):677-87.|
|Information||PCI vs. medical therapy
-At 3 months
--53% in PCI group angina-free vs. 42% medical-therapy (P<0.001)
-Benefit observed until 24 months
-No significant difference at 36 months
--Likely represents progression of CAD
|PAPER: Cost-effectiveness of percutaneous coronary intervention in optimally treated stable coronary patients.|
|Date||1 Sep 2008|
|Journal||Circ Cardiovasc Qual Outcomes. 2008 Sep;1(1):12-20.|
|Information||Cost-effectiveness analysis for PCI vs. medical therapy in stable CAD
-Cost ~$10,000, without significant gain in life-years or quality-adjusted life-years
-$168,000-$300,000 per QALY