Does the use of revascularization along with medical therapy improve CAD outcomes?

While there may be no particular survival benefit to performing revascularization on top of medical therapy (MT), the combination does seem to reduce the risk of poor outcomes, such as fatal myocardial infarction (MI) and unplanned revascularizations and stroke, recent meta-analysis reports.

Twelve randomized controlled trials were included in the analysis, resulting in a pooled sample of 15,774 patients with stable coronary artery disease (CAD). Revascularization was defined as the use of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or both. Trials were retrieved from the databases of Web of Science, the Cochrane Library, Embase, and Medline.

Pooled analysis of eight trials showed that the combination of revascularization and MT significantly reduced the risk of the composite outcome consisting of mortality, MI, revascularization, stroke, or rehospitalizations (relative risk [RR], 0.69, 95 percent confidence interval [CI], 0.55–0.87).

Taking the components individually, the combined approach likewise significantly decreased the likelihood of unplanned revascularizations (RR, 0.53, 95 percent CI, 0.40–0.71) and fatal MIs (RR, 0.65, 95 percent CI, 0.49–0.84).

On the other hand, add-on revascularization had no significant advantage over MT alone in terms of all-cause mortality (RR, 0.95, 95 percent CI, 0.86–1.06), overall MI (RR, 0.96, 95 percent CI, 0.80–1.15), and stroke (RR, 0.99, 95 percent CI, 0.62–1.44). The same was true for nonfatal MI, cardiovascular disease deaths, and heart failure.

“Among CAD patients with stable angina pectoris, shared clinical decision-making should occur to align therapy with patients preferences between invasive strategy plus MT compared to MT use only,” the researchers said.