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Cardiovascular Perspectives

Does Percutaneous Coronary Intervention Reduce Mortality in Patients With Stable Chronic Angina

Are We Talking About Apples and Oranges?

Harindra C. Wijeysundera, MD and Dennis T. Ko, MD, MSc

From the Division of Cardiology (H.C.W., D.T.K.), Schulich Heart Centre; Department of Medicine (H.C.W., D.T.K.), Sunnybrook Health Sciences Centre, University of Toronto; and Institute for Clinical Evaluative Sciences (D.T.K.), Toronto, Ontario, Canada.

Correspondence to Dennis T. Ko, MD, MSc, Room G1-06, 2075 Bayview Avenue, Institute for Clinical Evaluative Sciences, Toronto, ON, Canada M4N 3M5. E-mail dennis.ko@ices.on.ca

Key Words: angina • angioplasty stents

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
"Does percutaneous coronary intervention (PCI) reduce mortality among patients with stable coronary artery disease?" Very few questions have been so hotly debated within the medical literature over the past decade. Invasive treatment with PCI has figured prominently in the treatment of patients with coronary artery disease, with >1.3 million PCIs performed in the United States in 2005.¹ The rapid growth in PCI as a viable alternative to medical therapy or coronary artery bypass graft (CABG) surgery was catalyzed initially by the esthetic appeal of this less invasive procedure to improve flow in the coronary arteries and was subsequently reinforced by the improved ease and safety of PCI. Proponents of PCI argue that improved blood flow leads to reduced ischemic substrate and improved overall prognosis,² whereas opponents claim that patients with stable coronary artery disease have coronary plaques that are less likely to result in an acute coronary syndrome.³ Therefore, intervening focally on a coronary lesion via PCI is unlikely to alter their overall prognosis.

This conclusion has been supported by earlier meta-analyses and by the recently published Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) study, the largest trial to date to address whether PCI is beneficial as compared with medical therapy among patients with stable coronary artery disease.^3,4 These studies consistently indicated no risk reduction in the incidence of myocardial infarction or death associated with PCI. In an attempt to update the latest evidence such as the COURAGE trial, Schömig et al² surprisingly found that PCI was associated . . . [Full Text of this Article]