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Percutaneous coronary revascularization in coronary artery disease: Lessons from a single center experience
Catheterization and Cardiovascular Interventions, 05/09/2012
Aksoy O et al. – This single center registry analysis demonstrated better survival in stable CAD patients undergoing PCI compared to medical management alone. These data suggest there may be a benefit of PCI beyond symptom relief. Future randomized trials are needed to further understand the role of PCI in broader patient populations.
Methods- Using institutional diagnostic catheterization database of consecutive patients undergoing coronary angiography from 1/2004 to 1/2010, authors examined records for patients with a positive stress test and >70% coronary stenosis or symptoms of angina and >80% coronary stenosis.
- Authors excluded those with acute coronary syndromes, low ejection fraction (EF), history of CABG, and CABG following index catheterization.
- They stratified patients by treatment and performed unadjusted and propensity matched analyses.
- The outcome was all–cause mortality obtained from the Social Security Death Index.
- Authors identified 3,375 patients using study inclusion criteria.
- Mean age was 65 ± 11 years and 69% (n=2332) were men.
- Mean EF was 55 ± 8%.
- In the unadjusted cohort, 1265 patients received medical management and 2110 received PCI.
- The unadjusted analysis revealed significantly better survival in PCI patients (p<0.0001) (HR: 0.51; 95% confidence interval (CI), 0.41–0.63).
- Propensity matching was performed for 1,580 patients and analysis showed better survival among patients receiving PCI (0=0.04) (HR: 0.74; 95% CI, 0.55–0.98).
- PCI continued to show better survival after excluding patients with malignancy (p=0.03) and unstable angina (p=0.007).