title: Percutaneous coronary intervention outcomes in patients with stable obstructive coronary artery disease and myocardial ischemia: a collaborative meta-analysis of contemporary randomized clinical trials.
abstract: OBJECTIVE
  Myocardial ischemia in patients with stable coronary artery disease (CAD) has been repeatedly associated with impaired survival. However, it is unclear if revascularization with percutaneous coronary intervention (PCI) to relieve ischemia improves outcomes compared with medical therapy (MT).
  
  
  OBJECTIVE
  The objective of this study was to compare the effect of PCI and MT with MT alone exclusively in patients with stable CAD and objectively documented myocardial ischemia on clinical outcomes.
  
  
  METHODS
  MEDLINE, Cochrane, and PubMed databases from 1970 to November 2012. Unpublished data were obtained from investigators.
  
  
  METHODS
  Randomized clinical trials of PCI and MT vs MT alone for stable coronary artery disease in which stents and statins were used in more than 50% of patients.
  
  
  METHODS
  For studies in which myocardial ischemia diagnosed by stress testing or fractional flow reserve was required for enrollment, descriptive and quantitative data were extracted from the published report. For studies in which myocardial ischemia was not a requirement for enrollment, authors provided data for only those patients with ischemia determined by stress testing prior to randomization. The outcomes analyzed included death from any cause, nonfatal myocardial infarction (MI), unplanned revascularization, and angina. Summary odds ratios (ORs) were obtained using a random-effects model. Heterogeneity was assessed using the Q statistic and I2.
  
  
  RESULTS
  In 5 trials enrolling 5286 patients, myocardial ischemia was diagnosed in 4064 patients by exercise stress testing, nuclear or echocardiographic stress imaging, or fractional flow reserve. Follow-up ranged from 231 days to 5 years (median, 5 years). The respective event rates for PCI with MT vs MT alone for death were 6.5% and 7.3% (OR, 0.90 [95% CI, 0.71-1.16); for nonfatal MI, 9.2% and 7.6% (OR, 1.24 [95% CI, 0.99-1.56]); for unplanned revascularization, 18.3% and 28.4% (OR, 0.64 [95% CI, 0.35-1.17); and for angina, 20.3% and 23.3% (OR, 0.91 [95% CI, 0.57-1.44]).
  
  
  CONCLUSIONS
  In patients with stable CAD and objectively documented myocardial ischemia, PCI with MT was not associated with a reduction in death, nonfatal MI, unplanned revascularization, or angina compared with MT alone.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, State University of New York-Stony Brook School of Medicine, Stony Brook.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Stergiopoulos
authors.affiliation: Samuel S Stratton VA Medical Center, Albany Medical Center, Albany, New York.
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.affiliation: VA Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven.
authors.forename: Pamela
authors.initials: P
authors.lastname: Hartigan
authors.affiliation: Universität Leipzig, Leipzig, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Möbius-Winkler
authors.affiliation: Klinikum, Links der Weser GmbH, Chefarzt Klinik für Kardiologie und Angiologie, Bremen, Germany.
authors.forename: Rainer
authors.initials: R
authors.lastname: Hambrecht
authors.affiliation: Heart Institute of the University of Sao Paolo, Sao Paolo, Brazil.
authors.forename: Whady
authors.initials: W
authors.lastname: Hueb
authors.affiliation: Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania.
authors.forename: Regina M
authors.initials: RM
authors.lastname: Hardison
authors.affiliation: Warren Alpert Brown University School of Medicine, Providence, Rhode Island.
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, State University of New York-Stony Brook School of Medicine, Stony Brook.
authors.forename: David L
authors.initials: DL
authors.lastname: Brown
mesh_terms: D023921:Coronary Stenosis / Q000601:surgery*; D006801:Humans; D017202:Myocardial Ischemia / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome