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Comment & Response |

Percutaneous Coronary Intervention vs Medical Treatment in Stable Angina The Never-Ending Story

Eliano Pio Navarese, MD, PhD1,3; Mariusz Kowalewski, MD2,3; Harry Suryapranata, MD1
[+] Author Affiliations
1Department of Cardiology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
210th Military Research Hospital and Polyclinic, Bydgoszcz, Poland
3Systematic Investigation and Research on Interventions and Outcomes (SIRIO) MEDICINE Research Network
JAMA Intern Med. 2014;174(7):1199-1200. doi:10.1001/jamainternmed.2014.1529.
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To the Editor We read with interest the article by Stergiopoulos et al,1 who conclude that in patients with stable coronary artery disease and objectively documented ischemia, percutaneous coronary intervention (PCI) was not associated with a reduction in clinical end points compared with medical therapy (MT) alone. While interesting, this meta-analysis might be flawed in several ways.

Study inclusion: Of the 5 randomized trials included in the current meta-analysis, 4 (Medicine, Angioplasty, or Surgery Study II [MASS-II], Clinical Outcomes Using Revascularization and Aggressive Drug Evaluation [COURAGE], Hambrecht et al, and Bypass Angioplasty Revascularization 2 Diabetes [BARI-2D]) do not reflect current clinical practice anymore with regard to ischemia-driven strategy of both primary PCI and PCI deferral with optimal MT, with a minimal use of contemporary revascularization strategies.2


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