A meta-analysis of randomised controlled trials comparing percutaneous coronary intervention with optimal medical therapy in chronic coronary syndrome

Introduction: The optimal treatment for patients suffering from chronic coronary syndrome (CCS) is controversial. Many studies have examined the value of performing percutaneous coronary intervention (PCI) in these patients but so far, no study has been able to demonstrate an improvement in outcomes by performing PCI in addition to optimal medical therapy (OMT). This study aimed to examine the added value of performing PCI plus OMT versus OMT alone regarding cardiovascular outcomes.

Material and method: We performed a systematic search and a meta-analysis for studies comparing PCI plus OMT versus OMT in CCS patients. We included only randomized controlled trials from the past 15 years. Studies were excluded if stent implantation rate was less than 50% and if statins were used in less than 50% of patients in both PCI and OMT arms.

Results and discussion: The systematic search and study selection process resulted in 6 trials [N= 11,144] with follow up ranges 2.2-11.4 years. The pooled analysis showed no significant difference between PCI plus OMT and OMT groups regarding all-cause mortality [OR = 0.98 (CI, 0.86 – 1.12, p = 0.79, I² = 0%)]. In addition, we have found no difference between the two groups regarding cardiovascular mortality [OR = 0.91 (CI, 0.76 – 1.08, p = 0.27, I² = 24%)]. Moreover, there was no difference in the incidence of myocardial infarction [OR = 0.92 (CI, 0.81 – 1.04, p = 0.18, I² = 49%)]. This meta-analysis is the only analysis to date that compared PCI with stent implantation plus OMT versus OMT alone in CCS and provides an insight that should be considered when treating these patients.

Conclusions: Our results suggest that there is no added value of performing PCI plus OMT versus OMT alone regarding cardiovascular outcomes in patients with CCS.