Evaluating the efficacy and safety of percutaneous coronary intervention (PCI) versus the optimal drug therapy (ODT) for stable coronary heart disease: a systematic review and meta-analysis

Abstract

Background: Many studies have reported potential benefits of percutaneous coronary intervention (PCI) versus optimal drug therapy (ODT) for patients with stable coronary heart disease but with inconsistent results. To examine this, an explicit systematic review and meta-analysis was conducted to compared the clinical outcomes of PCI and ODT in these patients. Methods: The following terms were combined to search relative articles through databases PubMed, Cochrane Central Register of Controlled Trials, Embase, and Web of Science published from January 2010 to November 2021 according to Participants, Intervention, Control, Outcomes, Study (PICOS) criteria:"coronary heart disease", "stable coronary heart disease", "stable angina pectoris", "percutaneous coronary intervention", "PCI", "percutaneous transluminal coronary angioplasty", "drug therapy", "optimized drug treatment", and "optimized drug therapy". The meta-analysis was performed by RevMan 5.2, and the Cochrane risk of bias tool was used to evaluate the quality of the included studies.Results: A total of 12 articles were included in the final analysis. There were 4,288 cases of PCI patients and 4,261 cases of ODT patients. The results showed that, when comparing PCI with ODT, there was a significant difference in the probability of myocardial infarction [relative risk (RR) =0.63; 95% confidence intervals (CI): 0.45-0.90] and the patient mortality (RR =0.51; 95% CI: 0.40-0.64). However, there was no significant difference in the prevalence of stroke (RR =1.33; 95% CI: 0.82-2.17), revascularization (RR =0.86; 95% CI: 0.46-1.62) and patient quality of life (MD =10.44; 95% CI: −1.84 to 22.73). Performance bias and detection bias were all unclear in the included studies and should be warned.Discussion: Compared with ODT, PCI reduced the mortality and myocardial infarction rate of patients with CTO or severe coronary artery stenosis. However, the incidence of stroke, revascularization, and quality of life of patients were not significant different between PCI and ODT. Performance bias and detection bias should be cautioned.

Percutaneous coronary intervention versus optimal medical therapy for stable coronary artery disease: An umbrella review

“…After eliminating duplicate articles, we evaluated 194 records by title and abstract, of which 23 were reviewed in full text, and finally included 10 SRs with meta-analyses of RCTs [ 6 , 7 , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ] ( Fig. 1 ).…”

“…The number of meta-analyzed RCTs was 3–15. Seven SRs evaluated the risk of bias: 6 with the Cochrane tool [ 6 , 14 , 15 , [17] , [18] , [19] , [20] ] and 1 with the Jadad score [ 7 , 13 ]. None of the SRs used the GRADE approach to evaluate the certainty of the evidence.…”

“…Out of the 10 SRs, 9 included patients with stable coronary artery disease, and one included patients with chronic total occlusion [ 6 ]. The intervention in 5 SRs was exclusively PCI, in 4 it was exclusively or predominantly PCI, and one study evaluated PCI guided by fractional flow reserve using second-generation drug-eluting stents [ 20 ].…”

“…Of the 10 SRs with meta-analyses of RCTs, 9 evaluated the effect of PCI on all-cause mortality. Eight SRs found no significant differences between PCI and OMT, while one found that PCI decreased mortality compared to OMT [ 6 ]. Similarly, 8 SRs evaluated cardiovascular mortality and none found significant differences between PCI and OMT [ 7 , [14] , [15] , [16] , [17] , [18] , [19] , [20] ].…”

“…Regarding the use of PCI for stable coronary artery disease, while systematic reviews (SRs) have been published, they present heterogeneous results among themselves [ 6 , 7 ]. This makes it difficult to evaluate the balance between potential benefits and harms.…”