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Comparative Outcomes for Patients Who Do and Do Not Undergo Percutaneous Coronary Intervention for Stable Coronary Artery Disease in New York
Study Questions:
What is the outcome of patients with severe coronary artery disease (CAD) who are treated with percutaneous coronary intervention (PCI) versus those treated with medical therapy?
Methods:
The authors compared the outcome of patients with stable CAD who underwent cardiac catheterization in New York State between 2003 and 2008. Patients not receiving PCI and patients receiving PCI were propensity matched. The resulting cohort of 933 matched pairs was used to compare mortality/myocardial infarction (MI), mortality, MI, and subsequent revascularization rates.
Results:
Among the patients with significant CAD, PCI was performed in 89% of all patients. At follow-up of 4 years, patients treated with PCI had significantly lower mortality/MI (16.5% vs. 21.2%; p = 0.003), mortality (10.2% vs. 14.5%; p = 0.02), MI (8.0% vs. 11.3%; p = 0.007), and subsequent revascularization (24.1% vs. 29.1%; p = 0.005). After adjusting for baseline differences, absence of PCI was associated with an increase in the hazard of mortality/MI (hazard ratio [HR],1.49; 95% confidence interval [CI], 1.16-1.93) or mortality (HR,1.46; 95% CI, 1.08-1.97).
Conclusions:
Most patients with severe CAD in this study were treated with PCI. Patients who did not receive PCI were more likely to die or have an adverse cardiac event at follow-up.
Perspective:
This study adds to the growing number of comparative effectiveness studies that have demonstrated remarkably different results compared with those found in randomized controlled trials. It is highly unlikely that PCI would have reduced mortality or MI in the patients who were treated medically in this study. Further research is needed to elucidate and modify (if possible) the reasons for the high cardiovascular risk in these patients.
Keywords: Incidence, Coronary Artery Disease, Myocardial Infarction, Follow-Up Studies, Death, Cardiac Catheterization, Cardiovascular Diseases, Risk Factors, Angioplasty, New York, Percutaneous Coronary Intervention
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