“The inescapable fact is that it is increasingly harder to justify use of [stent implantation] solely for angina relief in such patients – especially as an initial approach to management, and if medical therapy has not been first instituted”
In short
MedWire News tells us today that initial coronary stent implantation shows no additional benefit over optimal medical therapy for the prevention of adverse outcomes in stable coronary artery disease (CAD) patients, according to a meta-analysis published in the Archives of internal Medicine (Arch Intern Med 2012; 172: 312–319, 319–321)
Background
The MedWire news article can be found here and in it researchers Kathleen Stergiopoulos and David Brown from Sony Brook University Medical Center, New York, identified eight prospective randomized trials that compared initial coronary stent implantation with medical therapy (including aspirin, beta blockers, ACE inhibitors, and statins) among a total of 7229 patients.
The study
Three trials enrolled stable patients after myocardial infarction (MI) and five trials enrolled patients who had stable angina and/or ischemia on stress testing.
Over a mean weighted follow-up of 4.3 years, 649 deaths occurred and there was no statistical difference between the initially stented and initially medicated groups.
Patients who received stent implantation were 12% more likely to experience nonfatal MI, but this association was also nonsignificant.
Stent patients were 22.0% less likely than medical therapy patients to undergo unplanned revascularization, although again this association was nonsignificant.
A nonsignificant association was also seen between angina status and initial intervention, 29% of the stent group compared with 33% of the medical therapy group suffered angina symptoms.
Investigator comments
“The findings of this analysis support current recommendations for instituting optimal medical therapy in patients with stable CAD rather than proceeding directly to stent implantation,” report Kathleen Stergiopoulos and David Brown from Stony Brook University Medical Center in New York, USA.
Editorialist William Boden (Samuel Stratton VA Medical Center, Albany, New York, USA) agrees that the current study provides no evidence for an enhanced benefit for CAD patients with either stent implantation or optimal medical therapy.
“The inescapable fact is that it is increasingly harder to justify use of [stent implantation] solely for angina relief in such patients – especially as an initial approach to management, and if medical therapy has not been first instituted,” he concludes.
Source: MedWire News
