Long Term Survival of Ischemic Heart Disease Patients Who Undergo Percutaneous Coronary Intervention

Aaron Nethercott, Mercer University College of Pharmacy

Ischemic heart disease (IHD) accounted for almost 380,000 deaths in 2010. According to the 2012 American College of Cardiology Foundation/American Heart Association/American College of Cardiology/American Association for Thoracic Surgery/Preventive Cardiovascular Nurses Association/Society of Thoracic Surgeons guidelines for the diagnosis and management of patents with stable ischemic heart disease, the medical management for IHD consists of aspirin, combinations of beta blockers and calcium channel blockers, blood pressure control, and smoking cessation.  The studies reviewed by the guidelines found no difference in survival or myocardial infarction rates between patients who received percutaneous coronary intervention (PCI) and standard medical therapy. Angina in patients with IHD has been shown to be reduce by PCI. [1]

Table 1

Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease [2]
Design Randomized trial, N = 2,287
Objective To evaluate survival among patients with ischemic heart disease who receive PCI compared to those who receive optimal medical therapy alone
Study Groups The PCI group initially had 1,149 patients.  Out of the original group, 613 patients were included in extended follow-up, of the extended follow up patients 54 died during the initial study.  The optimal medical therapy group initially had 1,138 patients.  Out of the original group, 598 were included in extended follow up. Of which, 95 died during the original study.
Methods The two groups were randomized to receive either PCI plus optimal medical therapy or optimal medical therapy alone.  The two groups were followed initial for a mean of 4.6 years in the COURAGE trial. The COURAGE trial was completed in 2007. After the conclusion of the COURAGE trail patients were selected for extended follow up in the use of this study.
Duration 15 years
Primary Outcome Measure Death form any cause
Baseline Characteristics Optimal medical therapy alone (n = 598) PCI plus optimal medical therapy (n = 613)
Age, years (standard deviation) 63 ± 10 63 ± 10
Male, % 90 93
BMI, kg/m2 30 ± 5 30 ± 5
Hypertension, % 79 77
Systolic blood pressure, mmHg 135 ± 19 135 ± 21
Diastolic blood pressure, mmHg 74 ± 11 74 ± 12
Results Optimal medical therapy Alone PCI plus optimal medical therapy p value
Number of deaths, n (%) 24 (4) 31 (6) 0.30
Adverse Events Common Adverse Events: Not reported
Serious Adverse Events: Not reported
Percentage that Discontinued due to Adverse Events: Not reported
Study Author Conclusions No difference was found find in survival between the PCI plus medical therapy group and medical therapy alone group in patients with stable ischemic heart disease.

The study found that there is no difference in long term survival of IHD patients who receive PCI compared to patients who only receive optimal medical therapy.  The studies reviewed by the IHD guidelines had relatively short durations.  This study was able to confirm the conclusion of the guidelines that there are no long-term benefits in the use of PCI in IHD patients.

References

  1. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):e354-471.
  1. Sedlis SP, Hartigan PM, Teo KK, et al. Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease. N Engl J Med. 2015;373(20):1937-46.
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