Revascularization Therapy in Stable Coronary Artery Disease

Pretorian A¹, Borda Angela², Dobreanu D³, Pretorian Ana-Maria¹

1 Department of Cardiology, Municipal Hospital, Gheorgheni, Romania
2 Department of Pathology, Faculty of Medicine, University of Medicine and Pharmacy, Târgu Mureş, Romania
3 Department of Cardiology, Institute of Cardiovascular Diseases and Transplantation, Târgu Mureş, Romania

Introduction: In patients with stable coronary artery disease, there are controversial studies that compare the optimal medical therapy with revascularization therapy in reducing the risk of cardiovascular events.
Material and method: The study included 221 patients with stable coronary artery disease who underwent coronarography and had objective evidence of significant coronary disease. Of these, 73 underwent percutaneous coronary intervention, 71 underwent coronary artery bypass grafting, both subgroups with optimal medical therapy, and 77 received optimal medical therapy alone. Primary outcomes were cardiac death and non fatal myocardial infarction, during a follow-up period of 4.5 years. Secondary outcomes were persistent disabling angina (quality of life) and the need for repeat revascularization.
Results: There were 15 primary events in the medical-therapy group, 5 events in the surgical group and 5 events in the percutaneous coronary intervention group. In subgroups analysis, among patients with non-high risk criteria (one or two-vessel disease, without significant ventricular dysfunction), the primary outcome was 2.5% in the medical group and 1.78% in the PCI group, while the persistent disabling angina occurred in 22.5% in the medical group versus 12.50% in the interventional group versus 18.75% in the coronary artery bypass grafting group (p = 0.42). Among high-risk criteria patients there was a tendency for increased repeat target vessel revascularization in the interventional group vs surgical group (17.64% vs 5.45%). The primary outcome was similar in both groups (11.76% vs 9.09%).
Conclusion: For patients with stable angina that is not significantly interfering with the quality of life and without high-risk characteristics, medical therapy rather than immediate revascularization seems to be the right option. Patients with high-risk criteria benefit from a more complete revascularization by coronary artery bypass grafting, but most often the patient will prefer the interventional aproach.