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No Benefit for Stent Versus Medical Therapy in Stable CAD

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.

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A meta-analysis of more than 7,000 patients suggests that there is no benefit to initial stent implantation over medical therapy in the treatment of patients with stable coronary artery disease, according to research published in the Feb. 27 issue of the Archives of Internal Medicine.

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