This paper suggests that patients with stable coronary artery disease who undergo elective coronary revascularization find a long-term benefit in terms of cardiac death compared with patients who receive medical treatment alone.
These findings, presented at EuroPCR 2021 and simultaneously published in the European Heart Journal, challenge the results from the ISCHEMIA trial.
Researchers state that the benefit in mortality could be directly linked to follow-up time. The longer the follow-up time, the greater the benefit observed in cardiac mortality and infarction with angioplasty or surgery.
Any doubts raised by this new meta-analysis will be answered relatively quickly. Researchers from the ISCHEMIA trial announced ISCHEMIA-EXTEND, which will add five more years of follow-up to the original study for over 5000 patients.
It is only a matter of time before we know the long-term all-cause mortality rates (approximately 10 years).
This meta-analysis included 25 studies and almost 20,000 patients with stable coronary artery disease who underwent elective revascularization vs. medical treatment.
Among the 25 studies, some are older—like MASS-1, RITA-2, and COURAGE—, while some are more recent—like ORBITA, FAME 2, and, of course, ISCHEMIA.
A 21% reduction in the risk of cardiac death (risk ratio [RR]: 0.79; 95% confidence interval [CI]: 0.67-0.93) was observed in patients who underwent revascularization vs. those who continued receiving medical treatment alone.
For each additional four years of follow-up, there was a 19% reduction in the risk of dying from cardiac causes among patients who underwent revascularization.
All-cause mortality was similar between both treatment strategies (RR: 0.94: 95% CI: 0.87-1.01). This is one of the reasons why researchers from ISCHEMIA-EXTEND decided on this endpoint instead of cardiac death.
This might be a heated argument in the future: does revascularization reduce mortality or does it just choose a non-cardiac death?
Original Title: Cardiac mortality in patients randomised to elective coronary revascularisation plus medical therapy or medical therapy alone: a systematic review and meta-analysis.
Reference: Navarese EP et al. Eur Heart J. 2021; Epub ahead of print. doi:10.1093/eurheartj/ehab246.
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