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26 Smith et al. 2005 ACC/AHA/SCAI Practice Guidelines ACC - www.acc.org AHA - www.americanheart.org SCAI - www.scai.org Table 12. PCI Comparison With Medical Therapy Patient Results Study Year Ref n Population Treatment Follow-Up PCI Medical Therapy Significance (P) ACME 1992 (296) 212 Patients with Medical therapy 6 mo 64% less angina 46% less angina Less than 0.01 single- vs vessel disease balloon angioplasty VA ACME 1997 (300) 328 Patients with Medical therapy 3 y 63% less angina 48% less angina 0.02 documented vs chronic balloon angioplasty stable angina 227 singlevessel disease 101 doublevessel disease ACIP 1997 (301) 558 Patients with Angina-guided 2 y 4.7% death or MI 8.8% death or MI Less than 0.01 documented CAD drug therapy for ischemia-guided and asymptomatic vs angina- drug therapy ischemia plus ischemia guided drug 12.1% death or MI 183 angina- therapy vs for angina-guided guided revascularization drug therapy drug therapy 183 angina- plus ischemia-guided drug therapy 192 revascularization by PTCA or CABG AVERT 1999 (298) 341 Patients with stable Medical therapy 18 mo 21% ischemic 13% ischemic 0.048; 0.045 CAD, normal with events events needed for LV function, and atorvastatin significance angina class I/II; vs PTCA due to interim patients required analysis to complete 4 min on Bruce protocol Continued on next page Comments The PTCA group had less angina, better exercise performance, and more improvement in quality-of-life scores but had more complications (emergency bypass 2 patients, MI in 5, and repeat PTCA in 16) Among patients with single-vessel disease, the PTCA group had less angina, better exercise performance, and more improvement in quality-of-life scores 40% of patients had previous MI, 23% had prior PTCA or CABG, and 38% had triple-vessel disease Only 2 deaths among 341 patients in 18 months; significant improvement in angina in patients treated with PTCA compared with medical therapy
ACC - www.acc.org AHA - www.americanheart.org SCAI - www.scai.org Smith et al. 2005 ACC/AHA/SCAI Practice Guidelines 27 Table 12. Continued Patient Results Study Year Ref n Population Treatment Follow-Up PCI Medical Therapy Significance (P) Comments RITA-2 2003 (299) 1018 53% with Medical therapy 7 y 14.5% 12.3% death 0.21 Class II angina vs death or MI or MI 47% with prior angina balloon 7% with triple- angioplasty vessel disease RITA-3 2002 (302) 1810 Suspected cardiac Medical therapy and 1 y 7.6% death 8.3% death NS chest pain at rest either early invasive or MI or MI with documented or conservative CAD (at least 1 of (selectively invasive) the following: treatment strategy; ECG changes, both groups received pathological enoxaparin in addition Q waves, previous to standard arteriogram) medical therapy PTCA group had increased rates of death and MI but had 6.4% less class II angina or worse at 5 years and longer exercise treadmill time at 3 years Similar results for death or MI between treatment groups; significant difference in primary end point (death, MI, refractory angina) due to halving of refractory angina in intervention group MASS-II 2004 (289) 611 Stable angina, Medical therapy, 1 y 4.5% death 1.5% death NS multivessel disease, CABG, or PCI preserved LV function Aggressive medical management for multivessel disease has low incidence of early events, including death and Q-wave MI, but is inferior to PCI (and CABG) for control of angina n indicates number of patients; CABG, coronary artery bypass graft; CAD, coronary artery disease; MI, myocardial infarction; PTCA, percutaneous transluminal coronary angioplasty; and PCI, percutaneous coronary intervention.
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