Stable Coronary Artery Disease: When is Percutaneous Coronary Intervention Indicated?
Keywords:coronary artery disease, coronary angioplasty, coronary stenting, percutaneous coronary intervention, coronary bypass surgery, acute coronary syndromes, ischemic heart disease, myocardial infarction
In patients with chronic coronary artery disease (CAD) and good left ventricular function, percutaneous coronary intervention (PCI) does not confer any clear benefit in terms of hard long-term clinical outcomes, such as mortality, myocardial infarction or the need for subsequent revascularization, as compared with medical conservative treatment. Indeed, a meta-analysis of early data from 6 randomised controlled trials has showed convincingly that PCI improves anginal symptoms compared to conservative management, but there has been limited evidence on the effect of PCI on hard clinical outcomes. At the same time, the early fear of increased need for revascularization after PCI is probably not warranted. By comparing the benefits against cost considerations, it seems that many percutaneous interventions that are currently performed in patients with non-acute CAD are probably not justified.
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