NEW YORK (Reuters Health) Mar 02 - In patients with nonacute coronary artery disease (CAD), surgical or percutaneous coronary artery revascularization in conjunction with medical therapy yields a survival advantage compared with medical management alone, according to a systematic review and meta-analysis of relevant published studies.
While timely revascularization significantly improves outcomes in patients with acute coronary syndromes, data are scarce regarding the impact of revascularization on patients with nonacute CAD, Dr. Allen Jeremias from New York's Stony Brook University Medical Center and colleagues note in the February issue of the American Journal of Medicine.
They identified 28 randomized clinical trials of coronary revascularization (surgical or percutaneous intervention) versus medical therapy alone in patients with nonacute CAD. The studies, which were published from 1977 to 2007, involved a total of 13,121 patients, of whom 6476 were randomized to revascularization and 6645 to medical therapy alone. Follow-up ranged from 1 to 10 years, with a median of 3 years.
A random effects model was used to calculate odds ratios for the two prespecified outcomes - death and nonfatal myocardial infarction reported at a minimum follow-up of 1 year, Dr. Jeremias and colleagues explain.
"In this large meta-analysis, what we find is that there is, in fact, a significant benefit in terms of mortality reduction in patients who do get revascularization," Dr. Jeremias noted in an interview with Reuters Health.
The odds ratio for revascularization versus medical therapy for mortality was 0.74. In an analysis stratified by revascularization mode, both bypass grafting (OR 0.62) and percutaneous intervention (OR 0.82) were found to be superior to medical therapy in avoiding mortality.
Revascularization was not associated with a significant reduction in nonfatal MI compared with medical therapy (OR 0.91).
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