E. Navarese et al. (Nicolaus Copernicus University, Poland) presented the results of a new meta-analysis of revascularisation plus medical therapy versus medical therapy alone in patients with chronic coronary syndromes. A total of 19,806 patients with chronic coronary syndromes undergoing elective revascularisation from 25 randomised trials were pooled.
The authors found a statistically significant 21% relative risk reduction in cardiac death with revascularization plus medical therapy. There was a parallel significant reduction in spontaneous myocardial infarction with revascularisation plus medical therapy. No difference was noted in all the other secondary outcomes (all-cause death, spontaneous myocardial infarction, any myocardial infarction and stroke). Take-home message: This meta-analysis suggests that the benefits of revascularisation and optimised medical therapy are additive. Their combination is required to achieve maximal and durable prevention of adverse events.