For patients with coronary artery disease, how does revascularization compare to medical therapy alone?

Reference
Jeremias A, et al. The impact of revascularization on mortality in patients with nonacute coronary artery disease. Am J Med. 2009;122:152-161.

Objective
To compare surgical or percutaneous revascularization with medical therapy alone to determine the impact of revascularization on death and nonfatal myocardial infarction in patients with coronary artery disease. Includes the COURAGE Trial

Short summary
“Revascularization by coronary bypass surgery or percutaneous intervention in conjunction with medical therapy in patients with nonacute coronary artery disease is associated with significantly improved survival compared with medical therapy alone” but the revascularization arm did not have any statistically significant reduction in nonfatal myocardial infarction compared to the medical therapy arm.

Particulars
Meta-analysis of randomized trials (identified in the Cochrane Central Register or in Medline) that compared coronary revascularization to medical therapy alone in patients with nonacute coronary disease. Studies had to report on death or nonfatal myocardial infarction with a minimum follow up of 1 year. The meta-analysis included 28 studies (1977-2007) that enrolled a total of 13,121 patients.  The meta-analysis includes patients who were post-MI.

Data
Figures 1 and 2 (pp.156, 157) show odds ratio (OR) and cumulative OR for overall mortality for revascularization (OR=0.74, cumulative OR=0.47) versus medical therapy alone.
Figure 3 (p. 158) shows OR for mortality comparing CABG (OR=0.62) to medical therapy and PCI (OR=0.82) to medical therapy alone.

Figure 4 (p. 159) shows OR for nonfatal MI for revascularization (OR=0.91) versus medical therapy alone.

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About Amy

Clinical Informationist at EUH Branch Library
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