An updated meta-analysis of optimal medical therapy with or without invasive therapy in patients with stable coronary artery disease

Author(s)

Bi, Lei ; Geng, Yu ; Wang, Yintang ; Li, Siyuan ; Sun, Kuogen ; Guo, Yiqi ; Zhang, Ou ; Zhang, Ping

• Document type: Journal article
• Source: BMC CARDIOVASCULAR DISORDERS; v. 24, n. 1, p. 8-pg., 2024-07-04.

Abstract

Background The efficacy of optimal medical therapy (OMT) with or without revascularization therapy in patients with stable coronary artery disease (SCAD) remains controversial. We performed a meta-analysis of randomized controlled trials (RCTs) that compared OMT with or without revascularization therapy for SCAD patients. Methods Studies were searched in PubMed, EMBASE, and the Cochrane Central Register of Clinical Trials from January 1, 2005, to December 30, 2023. The main efficacy outcome was a composite of all-cause death, myocadiac infarction, revascularization, and cerebrovascular accident. Results were pooled using random effects model and fixed effects model and are presented as odd ratios (ORs) with 95% confidence intervals (CI). Results Ten studies involving 12,790 participants were included. The arm of OMT with revascularization compared with OMT alone was associated with decreased risks for MACCE (OR 0.55 [95% CI 0.38-0.80], I-2=93%, P = 0.002), CV death (OR 0.84 [95% CI 0.73-0.97], I-2=36%, P = 0.02), revascularization (OR 0.32 [95% CI 0.20-0.50], I-2=92%, P < 0.001), and MI (OR 0.85 [95% CI 0.76-0.96], I-2=45%, P = 0.007). While there was no significant difference between OMT with revascularization and OMT alone in the odds of all-cause death (OR 0.94 [95% CI 0.84-1.05], I-2=0%, P = 0.30). Conclusions The current updated meta-analysis of 10 RCTs shows that in patients with SCAD, OMT with revascularization would reduce the risk for MACCE, cardiovascular death, and MI. However, the invasive strategy does not decrease the risks for all-cause mortality when comparing with OMT alone. (AU)

• FAPESP's process: 21/06730-7 - Towards sustainable zirconia recycled from milling waste and boosted by glass infiltration for restorative use, and of the development of strong, graded, and aging resistant multilayered zirconia blocks
• Grantee: Estevam Augusto Bonfante
• Support Opportunities: Research Grants - Young Investigators Grants - Phase 2
• FAPESP's process: 22/07157-1 - Physical and mechanical characterization of a multilayered system using recycled zirconia
• Grantee: Ernesto Byron Benalcazar Jalkh
• Support Opportunities: Scholarships in Brazil - Post-Doctoral