OBJECTIVE: To determine whether percutaneous transluminal coronary angioplasty (angioplasty) is superior to medical treatment in non-acute coronary artery disease. DESIGN: Meta-analysis of randomised controlled trials. SETTING: Randomised controlled trials conducted worldwide and published between 1979 and 1998. PARTICIPANTS: 953 patients treated with angioplasty and 951 with medical treatment from six randomised controlled trials, three of which included patients with multivessel disease and pre-existing myocardial infarction. MAIN OUTCOME MEASURES: Angina, fatal and non-fatal myocardial infarction, death, repeated angioplasty, and coronary artery bypass grafting. RESULTS: In patients treated with angioplasty compared with medical treatment the risk ratios were 0. 70 (95% confidence interval 0.50 to 0.98; heterogeneity P<0.001) for angina; 1.42 (0.90 to 2.25) for fatal and non-fatal myocardial infarction, 1.32 (0.65 to 2.70) for death, 1.59 (1.09 to 2.32) for coronary artery bypass graft, and 1.29 (0.71 to 3.36; heterogeneity P<0.001) for repeated angioplasty. Differences in the methodological quality of the trials, in follow up, or in single versus multivessel disease did not explain the variability in study results in any analysis. CONCLUSIONS: Percutaneous transluminal coronary angioplasty may lead to a greater reduction in angina in patients with coronary heart disease than medical treatment but at the cost of more coronary artery bypass grafting. Trials have not included enough patients for informative estimates of the effect of angioplasty on myocardial infarction, death, or subsequent revascularisation, though trends so far do not favour angioplasty.
OBJECTIVE: To determine whether percutaneous transluminal coronary angioplasty (angioplasty) is superior to medical treatment in non-acute coronary artery disease. DESIGN: Meta-analysis of randomised controlled trials. SETTING: Randomised controlled trials conducted worldwide and published between 1979 and 1998. PARTICIPANTS: 953 patients treated with angioplasty and 951 with medical treatment from six randomised controlled trials, three of which included patients with multivessel disease and pre-existing myocardial infarction. MAIN OUTCOME MEASURES: Angina, fatal and non-fatal myocardial infarction, death, repeated angioplasty, and coronary artery bypass grafting. RESULTS: In patients treated with angioplasty compared with medical treatment the risk ratios were 0. 70 (95% confidence interval 0.50 to 0.98; heterogeneity P<0.001) for angina; 1.42 (0.90 to 2.25) for fatal and non-fatal myocardial infarction, 1.32 (0.65 to 2.70) for death, 1.59 (1.09 to 2.32) for coronary artery bypass graft, and 1.29 (0.71 to 3.36; heterogeneity P<0.001) for repeated angioplasty. Differences in the methodological quality of the trials, in follow up, or in single versus multivessel disease did not explain the variability in study results in any analysis. CONCLUSIONS: Percutaneous transluminal coronary angioplasty may lead to a greater reduction in angina in patients with coronary heart disease than medical treatment but at the cost of more coronary artery bypass grafting. Trials have not included enough patients for informative estimates of the effect of angioplasty on myocardial infarction, death, or subsequent revascularisation, though trends so far do not favour angioplasty.
Authors: D B Mark; C D Naylor; M A Hlatky; R M Califf; E J Topol; C B Granger; J D Knight; C L Nelson; K L Lee; N E Clapp-Channing Journal: N Engl J Med Date: 1994-10-27 Impact factor: 91.245
Authors: J L Rouleau; L A Moyé; M A Pfeffer; J M Arnold; V Bernstein; T E Cuddy; G R Dagenais; E M Geltman; S Goldman; D Gordon Journal: N Engl J Med Date: 1993-03-18 Impact factor: 91.245
Authors: Michael Fiechter; Jelena R Ghadri; Mathias Wolfrum; Silke M Kuest; Aju P Pazhenkottil; Rene N Nkoulou; Bernhard A Herzog; Cathérine Gebhard; Tobias A Fuchs; Oliver Gaemperli; Philipp A Kaufmann Journal: Eur J Nucl Med Mol Imaging Date: 2011-12-06 Impact factor: 9.236
Authors: Simon A Mahler; Jason P Stopyra; Fred S Apple; Robert F Riley; Gregory B Russell; Brian C Hiestand; James W Hoekstra; Cedric W Lefebvre; Bret A Nicks; David M Cline; Kim L Askew; David M Herrington; Gregory L Burke; Chadwick D Miller Journal: Clin Biochem Date: 2017-01-10 Impact factor: 3.281
Authors: Rory Hachamovitch; Alan Rozanski; Sean W Hayes; Louise E J Thomson; Guido Germano; John D Friedman; Ishac Cohen; Daniel S Berman Journal: J Nucl Cardiol Date: 2006-11 Impact factor: 5.952