No Benefit for Stent Versus Medical Therapy in Stable CAD
Mar 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 American Heart Association was one of the first organizations to advocate dietary changes to decrease the risk of coronary heart disease (CHD). The organization's first recommendation appeared in 1957 advising a decrease in the amount of fat intake to decrease atherosclerosis risk. Today, a different approach is recommended, which considers the diet as a whole, with recommendations of what to both include and avoid. Among other nutritional and lifestyle recommendations, the AHA advises the consumption of 2 servings of fish weekly for both men and women.