Elective coronary revascularization with drug therapy in patients with stable coronary artery disease was associated with better clinical results compared to drug therapy alone, as the results of a systematic review and meta-analysis published in the European Heart Journal show.
Researchers searched publication databases for randomized trials of revascularization and medical therapies in patients with stable coronary artery disease. A total of 25 randomized studies with 19,806 patients were included.
The patients received drug therapy alone (n = 9783) or with elective revascularization (n = 10,023). Patients were followed up for an average of 5.7 (95% CI, 3.60-7.76) years.
Cardiac mortality occurred in 5.09% of the revascularization and 6.20% of the drug therapy cohorts (I2, 21%), which indicates a reduced risk of cardiac mortality (risk ratio [RR], 0.79; 95% CI, 0.67-0.93; P <.01).
In studies with patients with post-acute coronary syndrome (RR 0.82; 95% CI 0.73-0.94; p <0.01), chronic total occlusions (RR 0.80; 95% CI 0.67-0, 95; P <0.01) and coronary artery bypass grafting (RR 0.83; 95% CI 0.71-0.98; P = 0.03).
It has been observed that the duration of follow-up is a significant factor in cardiac death. Mortality decreased with increasing follow-up (b, -0.05; P = 0.008), reflecting a 19% decrease (RR, 0.81; 95% CI, 0.69-0.96) in risk for all others 4 years of follow-up time.
All-cause mortality occurred in 12.66% of the revascularization and 13.41% of the drug therapy cohorts (I2.0%). No significant effect was observed in any of the studies (RR 0.94; 95% CI 0.87-1.01; P = 0.11); however, removing a study at high risk of publication bias resulted in a significant association between revascularization and all-cause mortality (RR 0.90; 95% CI 0.83-0.99; P = 0.03).
Myocardial infarction and strokes occurred in 6.57% and 2.24% of the revascularization and 8.81% and 1.80% of the drug therapy cohorts (I2, 21%; I2, 27%). Revascularization was associated with a reduced risk of myocardial infarction (RR 0.74; 95% CI 0.64-0.86; P <0.01) but not stroke (RR 1.18; 95% CI 0.86 - 1.60; P = 0.30).
This study was limited by the differences in patient characteristics and heterogeneity for the type of coronary stent and the large amount of missing patient data.
The study authors concluded that elective coronary revascularization with drug therapy in patients with stable coronary artery disease was associated with reduced cardiac mortality and myocardial infarction.
Disclosure: Some authors stated links with biotech, pharmaceutical, and / or device manufacturers. For a full list of the author’s disclosures, see the original reference.
Navarese EP, Lansky AJ, Kereiakes DJ et al. Cardiac mortality in patients randomized to elective coronary revascularization plus drug therapy or drug therapy alone: a systematic review and meta-analysis. Eur Heart J. Published online May 18, 2021. doi: 10.1093 / eurheartj / ehab246
This article originally appeared on The Cardiology Advisor