Medical Versus Revascularization Therapy in the Management of Stable Angina Pectoris

Background: In patients with stable coronary artery disease, there are very few studies that compare the value of optimal medical therapy with revascularization therapy in reducing the risk of cardiovascular events.
Aim: To compare three therapeutic options for stable angina pectoris: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medication alone.
Methods: We studied 98 randomized patients with stable angina pectoris who underwent coronarography and had objective evidence of significant coronary disease. We assigned 36 patients to undergo PCI, 28 patients to undergo CABG, both subgroups with optimal medical therapy, and 34 patients with optimal medical therapy alone. Primary outcomes were cardiac death and non fatal myocardial infarction, during a follow-up period of 3 years.
Results: There were 3 primary events in the medical-therapy group, 1 event in the CABG group and 1 event in the PCI group. The 3-year cumulative primary-event rates were 2.8% in the PCI group, 3.6% in the CABG group and 11.8% in the medical-therapy group (P = 0.16).
Conclusion: In patients with disabling stable angina pectoris without high-risk criteria, the revascularization has the advantage of improving the long-term quality of life. In some patients with high-risk criteria, the percutaneous coronary intervention using drug-eluting stents can be a viable alternative to surgical revascularization.