{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T09:48:48Z","timestamp":1790934528669,"version":"4.1.0"},"reference-count":52,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2012,8]]},"abstract":"<jats:sec>\n            <jats:title>Background\u2014<\/jats:title>\n            <jats:p>The role of percutaneous coronary intervention (PCI) in the management of stable coronary artery disease remains controversial. Given advancements in medical therapies and stent technology over the last decade, we sought to evaluate whether PCI, when added to medical therapy, improves outcomes when compared with medical therapy alone.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results\u2014<\/jats:title>\n            <jats:p>We performed a systematic review and meta-analysis, searching PubMed, EMBASE, and CENTRAL databases, until January 2012, for randomized clinical trials comparing revascularization with PCI to optimal medical therapy (OMT) in patients with stable coronary artery disease. The primary outcome was all-cause mortality, and secondary outcomes included cardiovascular death, nonfatal myocardial infarction, subsequent revascularization, and freedom from angina. Primary analyses were based on longest available follow-up with secondary analyses stratified by trial duration, with short-term (\u22641 year), intermediate (1\u20135 years), and long-term (\u22655 years) time points. We identified 12 randomized clinical trials enrolling 7182 participants who fulfilled our inclusion criteria. For the primary analyses, when compared with OMT, PCI was associated with no significant improvement in mortality (risk ratio [RR], 0.85; 95% CI, 0.71\u20131.01), cardiac death (RR, 0.71; 95% CI, 0.47\u20131.06), nonfatal myocardial infarction (RR, 0.93; 95% CI, 0.70\u20131.24), or repeat revascularization (RR, 0.93; 95% CI, 0.76\u20131.14), with consistent results over all follow-up time points. Sensitivity analysis restricted to studies in which there was &gt;50% stent use showed attenuation in the effect size for all-cause mortality (RR, 0.93; 95% CI, 0.78\u20131.11) with PCI. However, for freedom from angina, there was a significant improved outcome with PCI, as compared with the OMT group (RR, 1.20; 95% CI, 1.06\u20131.37), evident at all of the follow-up time points.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions\u2014<\/jats:title>\n            <jats:p>In this most rigorous and comprehensive analysis in patients with stable coronary artery disease, PCI, as compared with OMT, did not reduce the risk of mortality, cardiovascular death, nonfatal myocardial infarction, or revascularization. PCI, however, provided a greater angina relief compared with OMT alone, larger studies with sufficient power are required to prove this conclusively.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.112.970954","type":"journal-article","created":{"date-parts":[[2012,8,8]],"date-time":"2012-08-08T05:46:18Z","timestamp":1344404778000},"page":"476-490","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":164,"title":["Percutaneous Coronary Intervention Versus Optimal Medical Therapy in Stable Coronary Artery Disease"],"prefix":"10.1161","volume":"5","author":[{"given":"Seema","family":"Pursnani","sequence":"first","affiliation":[{"name":"From the Johns Hopkins Bloomberg School of Public Health, Baltimore MD (S.P., F.K., P.K., R.G., N.C.); California Pacific Medical Center, San Francisco, CA (S.P., R.S.); and Division of Cardiology, New York University School of Medicine, New York, NY (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick","family":"Korley","sequence":"additional","affiliation":[{"name":"From the Johns Hopkins Bloomberg School of Public Health, Baltimore MD (S.P., F.K., P.K., R.G., N.C.); California Pacific Medical Center, San Francisco, CA (S.P., R.S.); and Division of Cardiology, New York University School of Medicine, New York, NY (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravindra","family":"Gopaul","sequence":"additional","affiliation":[{"name":"From the Johns Hopkins Bloomberg School of Public Health, Baltimore MD (S.P., F.K., P.K., R.G., N.C.); California Pacific Medical Center, San Francisco, CA (S.P., R.S.); and Division of Cardiology, New York University School of Medicine, New York, NY (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pushkar","family":"Kanade","sequence":"additional","affiliation":[{"name":"From the Johns Hopkins Bloomberg School of Public Health, Baltimore MD (S.P., F.K., P.K., R.G., N.C.); California Pacific Medical Center, San Francisco, CA (S.P., R.S.); and Division of Cardiology, New York University School of Medicine, New York, NY (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Newry","family":"Chandra","sequence":"additional","affiliation":[{"name":"From the Johns Hopkins Bloomberg School of Public Health, Baltimore MD (S.P., F.K., P.K., R.G., N.C.); California Pacific Medical Center, San Francisco, CA (S.P., R.S.); and Division of Cardiology, New York University School of Medicine, New York, NY (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard E.","family":"Shaw","sequence":"additional","affiliation":[{"name":"From the Johns Hopkins Bloomberg School of Public Health, Baltimore MD (S.P., F.K., P.K., R.G., N.C.); California Pacific Medical Center, San Francisco, CA (S.P., R.S.); and Division of Cardiology, New York University School of Medicine, New York, NY (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sripal","family":"Bangalore","sequence":"additional","affiliation":[{"name":"From the Johns Hopkins Bloomberg School of Public Health, Baltimore MD (S.P., F.K., P.K., R.G., N.C.); California Pacific Medical Center, San Francisco, CA (S.P., R.S.); and Division of Cardiology, New York University School of Medicine, New York, NY (S.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","unstructured":"The World Health Organization The top ten causes of death fact sheet. 2004. Available at: http:\/\/www.who.int\/mediacentre\/factsheets\/fs310\/en\/index.html. Accessed February 2 2012."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)09963-4"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90040-8"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199303113281002"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199303113281001"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199303113281003"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00644-5"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199706053362301"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(00)01213-4"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa025142"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(02)09894-X"},{"key":"e_1_3_2_13_2","first-page":"354","article-title":"Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC-II prospective randomised multicentre study.","volume":"1999","author":"The Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC) Investigators","unstructured":"The Fragmin and Fast Revascularization During Instability in Coronary Artery Disease (FRISC) Investigators. Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC-II prospective randomised multicentre study. Lancet. 1999;354:708.","journal-title":"Lancet"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200106213442501"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1053\/euhj.2001.2735"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.107.187930"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa070829"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0805796"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.110.978247"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.321.7253.73"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-152-6-201003160-00007"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.104.521864"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.051"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.18.1985"},{"key":"e_1_3_2_25_2","unstructured":"Higgins JPT Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009]. The Cochrane Collaboration. 2009. Available at: www.cochrane-handbook.org. Accessed December 20 2002."},{"key":"e_1_3_2_26_2","unstructured":"Review Manager (RevMan) [Computer program]. Version 5.1. Copenhagen: The Nordic Cochrane Centre. The Cochrane Collaboration. 2011."},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/0197-2456(86)90046-2"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000087605.09362.0e"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.103.24.2928"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.01.087"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199201023260102"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(98)00685-7"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(95)00384-3"},{"issue":"19","key":"e_1_3_2_34_2","first-page":"II107","article-title":"Five-year follow-op of the medicine, angioplasty, or surgery study (MASS): A prospective, randomized trial of medical therapy, balloon angioplasty, or bypass surgery for single proximal left anterior descending coronary artery stenosis.","volume":"100","author":"Hueb WA","year":"1999","unstructured":"Hueb WA, Soares PR, Almeida De Oliveira S, Ari\u00ea S, Cardoso RH, Wajsbrot DB, Cesar LA, Jatene AD, Ramires JA. Five-year follow-op of the medicine, angioplasty, or surgery study (MASS): A prospective, randomized trial of medical therapy, balloon angioplasty, or bypass surgery for single proximal left anterior descending coronary artery stenosis. Circulation. 1999;100(19 Suppl):II107\u2013II113.","journal-title":"Circulation"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2003.08.065"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.106.625475"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2008.08.002"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199907083410202"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.54.3.947585"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(97)00097-1"},{"key":"e_1_3_2_41_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)07298-X"},{"key":"e_1_3_2_42_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(03)00951-3"},{"key":"e_1_3_2_43_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.19.2017"},{"key":"e_1_3_2_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2006.07.068"},{"key":"e_1_3_2_45_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.95.8.2037"},{"key":"e_1_3_2_46_2","doi-asserted-by":"publisher","DOI":"10.1159\/000096951"},{"key":"e_1_3_2_47_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000140983.69571.ba"},{"key":"e_1_3_2_48_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000121360.31954.1F"},{"key":"e_1_3_2_49_2","first-page":"Suppl I:","article-title":"Medical therapy versus PTCA: a prospective, randomized trial in patients with asymptomatic coronary single-vessel disease (abstract).","volume":"88","author":"Sievers N","year":"1993","unstructured":"Sievers N, Hamm CW, Herzner A, Kuck KH Medical therapy versus PTCA: a prospective, randomized trial in patients with asymptomatic coronary single-vessel disease (abstract). Circulation. 1993;88:Suppl I:1297.","journal-title":"Circulation"},{"key":"e_1_3_2_50_2","first-page":"CD005313","article-title":"Primary stenting versus primary balloon angioplasty for treating acute myocardial infarction.","author":"Nordmann AJ","year":"2005","unstructured":"Nordmann AJ, Bucher H, Hengstler P, Harr T, Young J. Primary stenting versus primary balloon angioplasty for treating acute myocardial infarction. Cochrane Database Syst Rev. 2005;CD005313.","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_3_2_51_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2003.11.025"},{"key":"e_1_3_2_52_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.112.097014"},{"key":"e_1_3_2_53_2","unstructured":"International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) home page. 2012. Available at: https:\/\/www.ischemiatrial.org. Accessed June 11 2012."}],"container-title":["Circulation: Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCINTERVENTIONS.112.970954","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:36:09Z","timestamp":1715567769000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCINTERVENTIONS.112.970954"}},"subtitle":["A Systematic Review and Meta-Analysis of Randomized Clinical Trials"],"short-title":[],"issued":{"date-parts":[[2012,8]]},"references-count":52,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2012,8]]}},"alternative-id":["10.1161\/CIRCINTERVENTIONS.112.970954"],"URL":"https:\/\/doi.org\/10.1161\/circinterventions.112.970954","relation":{},"ISSN":["1941-7640","1941-7632"],"issn-type":[{"value":"1941-7640","type":"print"},{"value":"1941-7632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,8]]},"assertion":[{"value":"2012-02-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-07-12","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2012-08-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}