Original title: Percutaneous Coronary Intervention Versus Optimal Medical Therapy for Prevention of Spontaneous Myocardial Infarction in Subjects With Stable Ischemic Heart Disease. Reference: Sripal Bangalore et al. Circulation. 2013;127:769-781
In the context of coronary angioplasty complications may arise, such as a periprocedural infarction. However, this event does not have the same clinical consequences compared to a spontaneous infarction.
The goal of this meta analysis was to evaluate the incidence of the different types of myocardial infarction in patients with stable ischemic heart disease treated with PCI vs. optimal medical therapy (OMT). 8070 patients with stable chronic angina were included from 12 randomized studies that compared PCI vs. OMT. The average follow up was 5 years (between 1.5 to 10.2 years) and only a small number of patients in the angioplasty group received drug eluting stents.
PCI was associated to a significant 24% incidence reduction of spontaneous acute myocardial infarction (RR=0.76; 95% IC, 0.58–0.99) (type 1 infarction of the universal definition). ON the other hand, PCI was associated with a greater incidence of periprocedural infarction (type 4 infarction). If we take into account all infarction events together, we won´t see any differences between both strategies. (RR=0.96; 95% CI, 0.74–1.21). PCI was also associated with a reduction in all cause mortality rate, though it did not reach a significant statistical value. (RR=0.88; 95% CI, 0.75–1.03).
Conclusion:
PCI, compared to OMT, in patients with stable ischemic heart disease, was associated with a significant reduction of spontaneous MI risk (type 1 of the universal definition) and a tendency to lower mortality rate, although it did not reach a significant statistical value.
Editorial comment:
A lot has been written about the important difference in prognosis of spontaneous MI vs. periprocedural MI. The whole work revolves around this detail, since the tally simply tracks the number of infarction events, but the risk these events involve is very different. This difference in terms of risk can be perceived in the tendency to a lower mortality in patients treated with PCI.
SOLACI.ORG