Percutaneous coronary intervention in addition to optimal medical therapy for stabile coronary artery disease - A systematic review and meta-analysis

Objective: We evaluated the effect of percutaneous coronary interventions (PCI) in addition to optimal medical therapy in stable coronary artery disease (CAD). Methods: A systematic literature search was conducted in the online databases MEDLINE, EMBASE etc. in June 2010, updated in February 2013 in MEDLINE and completed by a hand search. Randomized controlled trials (RCT) and systematic reviews of RCT comparing PCI vs. no PCI in stable CAD were identified and evaluated. Results for death, myocardial infarction and angina pectoris of the RCTs using optimal medical therapy were combined with meta-analysis for relative risk (RR). The strength of the evidence was appraised based on GRADE. Results: After evaluation of 7 systematic reviews and 23 RCT 4 RCTs using optimal medical therapy (Betablockers, ASS, Statins in more than 80% and ACE-Inhibitors in more than 50% of patients the study) were identified. No significant difference was found for the risks of death and of myocardial infarction between the alternatives up to 5 years after beginning the therapy. The PCI reduced the proportion of patients with angina pectoris attacks up to 3 years after beginning the therapy, RR = 0,81 (95% CI: 0,71 to 0,92). The strength of the evidence was appraised as moderate. Conclusion: The use of PCI in addition to optimal medical therapy in stable CAD may reduce the proportion of patients with angina pectoris attacks up to 3 years after beginning the therapy.