Medicine by the Numbers

A Collaboration of TheNNT.com and AFP

Stents for Stable Coronary Artery Disease

 

Am Fam Physician. 2018 Jan 1;97(1):online.

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Details for This Review

Study Population: Adults, typically 55 to 65 years of age, mostly men, with stable nonacute coronary artery disease (not actively having ischemia or a myocardial infarction) diagnosed by abnormal exercise stress testing, nuclear or echocardiographic stress imaging, or fractional flow reserve (FFR)

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NO BENEFIT IN PATIENTS WITH STABLE NONACUTE CORONARY ARTERY DISEASE

BenefitsHarms

No benefit in patients with stable nonacute coronary artery disease in the five-year follow-up period

1 in 50 experienced a serious complication such as death, stroke, myocardial infarction, arrhythmia, hemorrhage

NO BENEFIT IN PATIENTS WITH STABLE NONACUTE CORONARY ARTERY DISEASE

BenefitsHarms

No benefit in patients with stable nonacute coronary artery disease in the five-year follow-up period

1 in 50 experienced a serious complication such as death, stroke, myocardial infarction, arrhythmia, hemorrhage

Efficacy End Points: Death, nonfatal myocardial infarction, angina symptoms

Harm End Points: Death, stroke, myocardial infarction, arrhythmia, hemorrhage, contrast media reaction

Narrative: Percutaneous coronary intervention (PCI), generally with stenting, is commonly used to open occluded coronary arteries. This review summarizes the evidence on the benefits of this procedure in patients diagnosed with stable nonacute coronary artery disease (without acute ischemia or myocardial infarction). This diagnosis is usually made after an abnormal exercise stress test, or nuclear or echocardiographic stress imaging.

The benefits of PCI in patients with acute ischemia (myocardial infarction) will be discussed in a future Medicine by the Numbers review.

The meta-analysis discussed here analyzed data on 5,286 patients from five trials. Patients with stable obstructive coronary artery disease were randomized to receive PCI and medical treatment or medical treatment alone. All patients had a previous positive stress test or abnormal FFR, which is a test commonly used in the cardiac catheterization laboratory to assess the significance of a coronary stenosis by passing a thin wire through the occlusion and measuring any drop in pressure. FFR allows for making treatment decisions based on impairment of blood flow, not just visualizing the stenosis. Not all patients included in the meta-analysis had FFR measured.

After an average of five years of follow-up, coronary stenting for stable nonacute coronary artery disease did not lead to statistically significant changes in the risk of death (7.3% in medical treatment group vs. 6.5% in PCI group; odds ratio [OR] = 0.90; 95% confidence interval [CI], 0.71 to 1.16; P = .42); nonfatal myocardial infarction (7.6% in medical treatment group vs. 9.3% in PCI group;

Author disclosure: No relevant financial affiliations.

References

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