Author + information
- Armin Arbab-Zadeh, MD, FACC⁎ ()
- ↵⁎Johns Hopkins University/Division of Cardiology, 600 North Wolfe Street/Blalock 524, Baltimore, Maryland 21287-0409
Schömig et al. (1) reported a meta-analysis addressing the mortality in patients with stable coronary artery disease randomized to medical therapy and coronary intervention involving 17 prospective studies. The investigators concluded that based on their data, “a PCI-based invasive strategy may improve long-term survival compared with a medical treatment-only strategy” (1).
In addition to the numerous flaws of this analysis pointed out by the accompanying editorial comment (2), the fundamental limitation lies in the fact that except for the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, none of the studies included in this analysis applied contemporary medical treatment. Even though the same can be said about the interventional strategy, the difference is that newer medical interventions, such as high-dose statins, dual platelet inhibition, adequate angiotensin-converting enzyme inhibition, and beta blockade, have shown in randomized prospective trials to reduce the risk of death and/or nonfatal myocardial infarction compared with the standard of care (3–5), while such randomized trials (including follow-up) failed to show reduction of death or myocardial infarction for newer interventional therapies, such as bare-metal or drug-eluting stenting (6–9).
The report by Schömig et al. (1) therefore is misleading and irrelevant for contemporary medical practice. We should accept that the COURAGE trial, despite some limitations, represents the best evidence currently available for guiding our approach to patients with stable coronary artery disease.
- American College of Cardiology Foundation
- Schömig A.,
- Mehilli J.,
- de Waha A.,
- Seyfarth M.,
- Pache J.,
- Kastrati A.
- O'Rourke R.A.
- Fox K.M.,
- EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators
- Serruys PW, de Jaegere P, Kiemeneij F, et al., on behalf of Benestent Study Group. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med;331:489–95.