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Optimal medical therapy with or without PCI for stable coronary disease.
- Source :
-
The New England journal of medicine [N Engl J Med] 2007 Apr 12; Vol. 356 (15), pp. 1503-16. Date of Electronic Publication: 2007 Mar 26. - Publication Year :
- 2007
-
Abstract
- Background: In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events.<br />Methods: We conducted a randomized trial involving 2287 patients who had objective evidence of myocardial ischemia and significant coronary artery disease at 50 U.S. and Canadian centers. Between 1999 and 2004, we assigned 1149 patients to undergo PCI with optimal medical therapy (PCI group) and 1138 to receive optimal medical therapy alone (medical-therapy group). The primary outcome was death from any cause and nonfatal myocardial infarction during a follow-up period of 2.5 to 7.0 years (median, 4.6).<br />Results: There were 211 primary events in the PCI group and 202 events in the medical-therapy group. The 4.6-year cumulative primary-event rates were 19.0% in the PCI group and 18.5% in the medical-therapy group (hazard ratio for the PCI group, 1.05; 95% confidence interval [CI], 0.87 to 1.27; P=0.62). There were no significant differences between the PCI group and the medical-therapy group in the composite of death, myocardial infarction, and stroke (20.0% vs. 19.5%; hazard ratio, 1.05; 95% CI, 0.87 to 1.27; P=0.62); hospitalization for acute coronary syndrome (12.4% vs. 11.8%; hazard ratio, 1.07; 95% CI, 0.84 to 1.37; P=0.56); or myocardial infarction (13.2% vs. 12.3%; hazard ratio, 1.13; 95% CI, 0.89 to 1.43; P=0.33).<br />Conclusions: As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy. (ClinicalTrials.gov number, NCT00007657 [ClinicalTrials.gov].).<br /> (Copyright 2007 Massachusetts Medical Society.)
- Subjects :
- Adrenergic beta-Antagonists therapeutic use
Aged
Angina Pectoris therapy
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Anticholesteremic Agents therapeutic use
Antihypertensive Agents therapeutic use
Combined Modality Therapy
Coronary Disease mortality
Drug Therapy, Combination
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Infarction epidemiology
Platelet Aggregation Inhibitors therapeutic use
Proportional Hazards Models
Risk Factors
Stroke epidemiology
Angioplasty, Balloon, Coronary
Coronary Disease drug therapy
Coronary Disease therapy
Myocardial Infarction prevention & control
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 356
- Issue :
- 15
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 17387127
- Full Text :
- https://doi.org/10.1056/NEJMoa070829