A new analysis is calling into question the rationale for many of the angioplasty procedures taking place today in patients with stable coronary artery disease (CAD). In a meta-analysis of more than 5000 patients, Angioplasty was no better than medical therapy in patients with documented ischemia.
Its routine in cardiology practice to advise angioplasty or revascularization if stress test is positive. Patients with ischemia have a worse prognosis than patients who don’t. Thus cardiology practice is focused on finding and treating ischemia. However, the analysis of this study suggests that this approach may not be the right one.
Brown and colleagues reviewed the literature for clinical trials of angioplasty and medical therapy for stable CAD conducted over the past 40 years, ultimately including five trials of 5286 patients. These were a small German trial published in 2004, plus MASS II , COURAGE , BARI 2D , and FAME 2 . In all, 4064 patients had myocardial ischemia documented by exercise, nuclear or echo stress imaging, or FFR.
Over a median follow-up of five years, mortality, nonfatal MI, unplanned revascularization, and angina were no different between patients treated medically vs those treated with Angioplasty.
The analysis suggests that it may be worthwhile to continue medical therapy in patients with minimal symptoms and not subject them to unnecessary intervention.