No Benefit for Stent Versus Medical Therapy in Stable CAD
March 01, 2012
Kathleen Stergiopoulos, M.D., Ph.D., and David L. Brown, M.D., of the Stony Brook University Medical Center in New York, conducted a meta-analysis of eight prospective randomized clinical trials identified from the literature and involving 7,229 patients who underwent either initial coronary stent implantation or medical therapy for treatment of stable CAD. The effect of each intervention on the mortality rate and incidence of nonfatal myocardial infarction, unplanned revascularization, and persistent angina was investigated.
The researchers found that the respective event rates for death after an average 4.3-year follow-up period were 8.9 percent with stent implantation and 9.1 percent with medical therapy (odds ratio [OR], 0.98; 95 percent confidence interval [CI], 0.84 to 1.16). The incidence of nonfatal myocardial infarction was 8.9 and 8.1 percent for stent implantation and medical therapy, respectively (OR 1.12; 95 percent CI, 0.93 to 1.34). Rates of unplanned revascularization (21 and 34 percent, respectively; OR, 0.78; 95 percent CI, 0.57 to 1.06) and persistent angina (29 and 33 percent, respectively; OR, 0.80; 95 percent CI, 0.60 to 1.05) were also similar between the two intervention groups.
"Initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal myocardial infarction, unplanned revascularization, or angina," the authors write.
The recent US Centers for Disease Control and Prevention’s (CDC) surveillance report, stated that this year’s flu season has crossed the threshold for being considered epidemic – that is, the proportion of deaths attributed to pneumonia and influenza (8.5%) through the 122 Cities Mortality Reporting System was above the agency’s epidemic threshold of 7%.