Comparison between Revascularization and Optimal Medical Therapy in Patients with Stable Angina Pectoris

Background and Regarding usefulness of revascularization versus optimal medical therapy in patients with stable angina pectoris, data are challenging. The aim of this 12-month follow-up study was to compare the survival benefit associated with revascularization versus optimal medical therapy on the patients with stable angina pectoris.
A prospective clinical study was conducted on 181 patients with stable angina pectoris or an evidence of myocardial ischemia that underwent coronary arteriography. Patients with left main or left main equivalent were excluded from our study. Of these patients, 57 received full medical therapy alone, 79 were assigned to the percutaneous coronary intervention (PCI) and 45 to the coronary artery bypass graft (CABG) group. The patients were compared for primary outcomes including cardiac death and non-fatal myocardial infarction and secondary outcomes including disabling angina by chi-square and Fisher’s exact test.
After 12 months, cardiac death occurred in 8.8% of patients in the medical group and 0.0% of patients in the PCI and CABG group. This was statistically significant (P = 0.004). Disabling angina occurred in 23.1% of patients in the medical group, 17.7% of patients in the PCI group, and 15.5% of patients in CABG group (P = 0.349). Cerebrovascular accident occurred in 1.9% of patients in the medical group, 1.3% of patients in the PCI group, and 6.7% of patients in CABG group (P = 0.167). These were not statistically significant.
Revascularization compared with the optimal medical therapy may be a better strategy in reducing cardiovascular mortality in patients with stable angina pectoris and suitable coronary anatomy.