Percutaneous coronary intervention: a review
Many studies have explored percutaneous coronary intervention, PCI, in patients with coronary artery disease to understand whether cardiovascular events and angina are relieved by PCI. In the trials COURAGE and ISCHEMIA, it was found that revascularization did not reduce cardiovascular events, but it was shown to relieve symptoms of angina. However, between the trials many medical improvements have been made. For example, stent technology has improved from the bare metal stents in the COURAGE trials, as well as a greater clinical understanding of the fact that angina is not solely due to epicardial obstructive disease. With these improvements, it is not likely that many large trials will go on to compare PCI and conservative therapy, as it is known that coronary artery disease treatment should be personalised and focus on treating cardiovascular risk factors. Furthermore, implementing coronary artery disease prevention programs which reaches populations involving people of colour and people from rural populations is essential.
This review by Weintraub WS et al. aimed to review the current understandings of PCI and coronary artery disease in clinical trials.
Data collected from recent trials and studies has suggested that coronary artery disease and stable ischaemic heart disease should be treated with optimal medical therapy instead of PCI. Preventative strategies are also hugely crucial in all communities.