Bayesian meta-analysis of percutaneous coronary intervention compared to optimal medical therapy in stable ischemic heart disease patients

Abstract

Background: While the benefit of PCI in acute coronary syndromes is well established, the role of PCI in stable ischemic heart disease (SIHD) is less well clear. Our purpose is to investigate about the combined risk ratio of death or Myocardial Infarction (MI) and all cause mortality among the trials that compare PCI and optimal medical therapy (OMT). Methods: A literature search on OVID/Medline, from 1946 until now, was used to identify all published paper that compared OMT vs PCI. Two clinician-researchers have independently reviewed, abstracted and recorded into common data base. Data were then scrutinized by a third investigator. Meta-analysis, using the DerSimonian and Laird model, was conducted on the abstracted data. Bayesian analysis was performed. Results: 16 main randomized clinical trials were identified. Meta-analyses showed no difference between PCI and OMT for the combined outcome of MI/death across all trials (RR: 0.975; 95%, CI: 0.754-1.261, W: 100%, I2=89.9%) and when we analyzed the stable angina and post MI trials separately (RR: 1.024 95% CI: 0.905-1.160, W: 100%, I2: 23.5%). Relative risk of all cause mortality was not reduced with PCI (pooled RR: 0.986; CI: 0.841-1.156; W: 100%; I2: 0%). Bayesian analysis results are showed in table 1. (Table presented) Conclusion: Our study confirms that PCI does not yield any additional benefit above OMT in patients with SIHD for the combined end points of MI/Death or all cause mortality alone.