Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: meta-analysis of randomized controlled trials

Arch Intern Med. 2012 Feb 27;172(4):312-9. doi: 10.1001/archinternmed.2011.1484.


Background: Prior meta-analyses have yielded conflicting results regarding the outcomes of treatment of stable coronary artery disease (CAD) with initial percutaneous coronary intervention (PCI) vs medical therapy. However, most of the studies in prior systematic reviews used balloon angioplasty as well as medical therapies that do not reflect current interventional or medical practices. We therefore performed a meta-analysis of all randomized clinical trials comparing initial coronary stent implantation with medical therapy to determine the effect on death, nonfatal myocardial infarction (MI), unplanned revascularization, and persistent angina.

Methods: Prospective randomized trials were identified by searches of the MEDLINE database from 1970 to September 2011. Trials in which stents were used in less than 50% of PCI procedures were excluded. Data were extracted from each study, and summary odds ratios (ORs) were obtained using a random effects model.

Results: Eight trials enrolling 7229 patients were identified. Three trials enrolled stable patients after MI, whereas 5 studies enrolled patients with stable angina and/or ischemia on stress testing. Mean weighted follow-up was 4.3 years. The respective event rates for death with stent implantation and medical therapy were 8.9% and 9.1% (OR, 0.98; 95% CI, 0.84-1.16); for nonfatal MI, 8.9% and 8.1% (OR, 1.12; 95% CI, 0.93-1.34); for unplanned revascularization, 21.4% and 30.7% (OR, 0.78; 95% CI, 0.57-1.06); and for persistent angina, 29% and 33% (OR, 0.80; 95% CI, 0.60-1.05).

Conclusion: Initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal MI, unplanned revascularization, or angina.

Publication types

  • Meta-Analysis

MeSH terms

  • Angina Pectoris / etiology
  • Angioplasty, Balloon, Coronary* / methods
  • Angioplasty, Balloon, Coronary* / statistics & numerical data
  • Combined Modality Therapy / methods
  • Combined Modality Therapy / statistics & numerical data*
  • Coronary Artery Disease* / complications
  • Coronary Artery Disease* / physiopathology
  • Coronary Artery Disease* / therapy
  • Disease Progression
  • Drug Therapy, Combination* / methods
  • Drug Therapy, Combination* / statistics & numerical data
  • Emergency Treatment / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mortality
  • Myocardial Infarction / etiology
  • Odds Ratio
  • Outcome and Process Assessment, Health Care
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Stents / statistics & numerical data