Logo for Stony Brook University
News and Media Relations header

Home

Media Relations

rss icon

 

Search Press Releases


 

Related News


Student Media

 


Social Media

facebook iconStony Brook University
twitter icon Stony Brook University
flickr iconStony Brook on Flickr
youtube icon Stony Brook YouTube

facebook icon Stony Brook Medicine
twitter icon  Stony Brook Medicine
facebook icon Stony Brook Childrens
twitter icon Stony Brook Kids

 

Medical Center & Health Care

 

Angioplasty May Not Be Better than Medical Therapy in Stable Disease
Study results in JAMA Internal Medicine led by Stony Brook cardiologists suggests reconsidering strategy of revascularization

STONY BROOK, N.Y., December 6, 2013 – For patients with stable coronary artery disease (CAD) who are not experiencing a heart attack and an abnormal stress test, treatment of their narrowed arteries by the common procedure of angioplasty may not provide additional benefits compared to drug therapy alone. This finding results from a survey of more than 4,000 patients with myocardial ischemia, or inadequate circulation, led by cardiologists at Stony Brook University School of Medicine. The survey results are published in the online first edition of JAMA Internal Medicine .

placeholder

David L. Brown, MD

In the research paper titled “Percutaneous Coronary Intervention Outcomes in Patients With Stable Obstructive Coronary Artery Disease and Myocardial Ischemia: A Collaborative Meta-analysis of Contemporary Randomized Clinical Trials,” David L. Brown, MD, and Kathleen Stergiopoulos, MD, PhD, Professors in the Department of Medicine, Division of Cardiovascular Medicine at Stony Brook University School of Medicine, worked with colleagues internationally to design a data study that combined data from clinical trials performed between 1970 and 2012 of patients who had either percutaneous coronary intervention (PCI), or angioplasty, plus drug therapy, or drug therapy alone to treat their CAD.

Each of the clinical studies within the analysis reported outcomes of death and nonfatal myocardial infarction reported. Additionally, to reflect contemporary medical and interventional practice, inclusion criteria required stent implantation in at least 50 percent of the PCI procedures and statin medications to lower cholesterol in at least 50 percent of patients in both the PCI and drug therapy alone groups. This led to a total of five clinical trials yielding 4,064 patients with myocardial ischemia diagnosed by exercise stress testing, nuclear or echocardiocraphic stress imaging, or fractional flow reserve.

The researchers reviewed outcomes data up to five years post PCI or drug treatment alone. They analyzed all-cause death, non-fatal myocardial infarction, unplanned revascularization, and angina in the patients.

The analysis showed all-cause death rates between the two groups was not significantly different – 6.5 percent for patients receiving PCI and drug therapy versus 7.3 percent for patients receiving drug therapy alone. There was little difference in the rates of non-fatal myocardial infarction (9.2 percent with PCI vs. 7.6 percent drug therapy) and recurrent or persistent angina (20.3 percent vs. 23.3). The rate of unplanned revascularization was slightly different but not statistically significant (18.3 percent vs. 28.4 percent).

“If our findings are confirmed in ongoing trials, many of the more than 10 million stress tests performed annually and subsequent revascularizations may be unnecessary,” said Dr. Brown.

He cautioned that additional studies beyond data analyses of clinical trials are necessary to fully determine if practices with PCI in stable CAD patients needs to be re-evaluated, and if so, under what circumstances and in which patient populations.