Conflict of interest: There are no conflicts of interest to be reported by any of the authors. There were no funding necessary for this study as all data collection and analyses were performed using internal resources.
Coronary Artery Disease
Percutaneous coronary revascularization in coronary artery disease: Lessons from a single center experience†
Article first published online: 8 NOV 2012
Copyright © 2012 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 81, Issue 1, pages E1–E8, 1 January 2013
How to Cite
Aksoy, O., Tuzcu, E. M., Ellis, S. G., Whitlow, P. L., Cam, A., Batizy, L., Agarwal, S., Franco, I., Bajzer, C., Simpfendorfer, C., Raymond, R., Nair, R., Cho, L., Shishehbor, M. H., Lincoff, A. M. and Kapadia, S. R. (2013), Percutaneous coronary revascularization in coronary artery disease: Lessons from a single center experience. Cathet. Cardiovasc. Intervent., 81: E1–E8. doi: 10.1002/ccd.24442
- Issue published online: 21 DEC 2012
- Article first published online: 8 NOV 2012
- Accepted manuscript online: 16 APR 2012 08:00AM EST
- Manuscript Accepted: 9 APR 2012
- Manuscript Revised: 27 MAR 2012
- Manuscript Received: 13 MAR 2012
- percutaneous coronary intervention;
- coronary artery disease;
- optimal medical therapy
To determine the role of percutaneous coronary intervention (PCI) and its impact on mortality in coronary artery disease (CAD).
It's unclear whether PCI provides benefit in patients with CAD outside of acute settings. We sought to determine the role of PCI and its effect on mortality in patients with similar entry criteria to prior RCTs and compare outcomes with medical treatment.
Using institutional diagnostic catheterization database of consecutive patients undergoing coronary angiography from 1/2004 to 1/2010, we examined records for patients with a positive stress test and >70% coronary stenosis or symptoms of angina and >80% coronary stenosis. We excluded those with acute coronary syndromes, low ejection fraction (EF), history of CABG, and CABG following index catheterization. We stratified patients by treatment and performed unadjusted and propensity matched analyses. The outcome was all-cause mortality obtained from the social security death index.
We identified 3,375 patients using study inclusion criteria. Mean age was 65 ± 11 years and 69% (n = 2,332) were men. Mean EF was 55% ± 8%. In the unadjusted cohort, 1,265 patients received medical management and 2,110 received PCI. The unadjusted analysis revealed significantly better survival in PCI patients (P < 0.0001) (HR: 0.51; 95% confidence interval (CI), 0.41–0.63). Propensity matching was performed for 1,580 patients and analysis showed better survival among patients receiving PCI (0 = 0.04) (HR: 0.74; 95% CI, 0.55–0.98). PCI continued to show better survival after excluding patients with malignancy (P = 0.03) and unstable angina (P = 0.007).
This single center registry analysis demonstrated better survival in stable CAD patients undergoing PCI compared to medical management alone. These data suggest there may be a benefit of PCI beyond symptom relief. Future randomized trials are needed to further understand the role of PCI in broader patient populations. © 2012 Wiley Periodicals, Inc.