NEW YORK (Reuters Health) – As initial therapy in patients with low-risk, stable coronary artery disease, percutaneous coronary intervention (PCI) added to medical therapy is more effective than medical therapy alone in preventing acute coronary syndrome, according to a large multicenter trial conducted in Japan.

The Japanese Stable Angina Pectoris study compared long-term outcomes among patients at 78 centers randomly assigned to PCI plus medical therapy or medical therapy alone (192 in each group). The patients had 1- or 2-vessel disease in low-risk arteries and stable angina.

During a median follow-up of 3.3 years, cumulative rates of acute coronary syndrome were significantly lower in the PCI group (5.0% vs 11.7%, p = 0.012), Dr. Hisayoshi Fujiwara and colleagues report in the Journal of the American College of Cardiology: Cardiovascular Interventions.

According to the investigators, the severity of angina symptom was significantly lower in the early PCI group at 1 and 6 months, and at annual follow-ups. Rates of subsequent elective revascularization (21.4% vs 36.5%, p = 0.0011) and emergency hospitalizations (20.6% vs 31.6%, p = 0.042) were also lower in the group with early PCI.

Dr. Fujiwara, at Gifu University Graduate School of Medicine, and associates observed no significant differences between early PCI and medical therapy alone in number of deaths (6 vs 7), strokes (2 in each group), or acute myocardial infarctions (3 vs 7).

“In patients with low-risk coronary artery disease, PCI plus medical therapy treatment may improve long-term prognosis more effectively than initial medical therapy treatment,” the research team concludes.

However, in a related editorial, Dr. Abhiram Prasad and Bernard J. Gersh at Mayo Clinic in Rochester, Minnesota, make the point that “the major lessons of almost 3 decades of trials of revascularization versus medical therapy in patients with chronic stable angina and preserved left ventricular systolic function need to be reinforced.”

Specifically, “there is no difference in the ‘hard’ endpoints of death and myocardial infarction with either strategy.”

Reference:
J Am Coll Cardiol Intv 2008;1:469-482.