Death and MI following initial revascularization versus optimal medical therapy in chronic coronary syndrome: A systemic review & Meta-analysis of RCT

Recently a meta-analysis was conducted on 7 randomized controlled trials of PCI or CABG plus Optimal Medical Therapy (OMT) versus OMT alone involving 10797 patients with chronic coronary syndromes This is the first meta‐analysis to include patients with CCS and severely reduced left ventricular ejection fraction as well as those with CKD. This is the only meta‐analysis with documented myocardial ischemia and in which revascularization included both PCI and CABG. After a follow-up of 5 years, it was found that initial revascularization with PCI or CABG plus OMT did not reduce long‐term mortality compared with OMT alone. In subgroup analysis, CABG plus OMT reduced non-fatal MI and not PCI plus OMT, in comparison to  OMT alone therapy. Thus it can be concluded that in patients with only chronic coronary syndrome, the decision of revascularization should be based on discussions of symptom relief and quality of life and not about a reduction in mortality. Secondly, for patients in whom reduction in MI is an overarching goal, such as those with severely reduced left ventricular ejection fraction, CABG plus optimal medical therapy is superior to OMT and PCI plus OMT. Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.