[Comparative efficacy of conservative and invasive treatment of patients with stable form of ischemic heart disease (according to results of five year prospective study)].

Despite high immediate efficacy of percutaneous coronary interventions (PCI) in relation to symptoms of angina the problem of influence of this method of treatment on duration of life and prognosis in stable ischemic heart disease (IHD) remains unsolved. Aim of our study was to compare efficacy of conservative therapy with drugs of proven effect on prognosis and of percutaneous coronary interventions in combination with optimal drug therapy in patients with stable ischemic heart disease (IHD) during 5 years of follow up. We included into this study 503 patients (387 men and 116 women, mean age 59 years). Groups of conservative and invasive treatments comprised 179 and 302 patients, respectively; mean durations of follow-up were 5.6+/-1.3 and 4.1+/-1.6 years, respectively, p=0.001. Study end points were fatal and nonfatal cardiovascular complications (CVC) (cardiovascular death, acute coronary syndrome, transitory ischemic attack, peripheral arterial thrombosis) and composite endpoint defined as sum of all CVC and cases of revascularization of the involved vascular bed. Cumulative rates of all fatal and nonfatal CVCs was 5.3 and 4.8 per 100 patient/years in groups of conservative and invasive treatment, respectively (relative risk [RR] 0.96, 95% confidence interval [CI] 0.6 to 1.5; p=0.9). Rates of composite end point were 7.1 and 7.3 per 100 years in groups of conservative and invasive treatment, respectively (relative risk [RR] 1.02, 95% confidence interval [CI] 0.7 to 1.3; p=0.8). According to the presence of independent clinical predictors of worst prognosis (class II-III angina, history of myocardial infarction, three vessel or left main stem coronary artery disease, concomitant signs of atherothrombosis in cerebral and peripheral vascular beds, obesity, abnormal renal function, history of erosive gastritis) all patients were divided in groups of low, moderate, and high risk. In low risk IHD patients invasive strategy worsened remote prognosis of myocardial infarction, stroke, and cardiovascular death, as well as of repetitive revascularization.