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ACC: Medical Therapy Alone OK for Stable Coronary Disease

Preventive percutaneous coronary intervention does not reduce mortality or morbidity risk

MONDAY, March 26 (HealthDay News) -- Patients with stable coronary artery disease can be safely treated with medical therapy alone without percutaneous coronary intervention, according to a report published online March 26 in the New England Journal of Medicine to coincide with the American College of Cardiology's meeting in New Orleans. Performing an angioplasty does not appear to reduce mortality or morbidity in such patients.

William E. Boden, M.D., of Buffalo General Hospital in Buffalo, N.Y., and colleagues conducted a trial with 2,287 patients from 50 U.S. and Canadian centers. The patients had evidence of myocardial ischemia and significant coronary artery disease and were randomized to undergo percutaneous coronary intervention and optimal medical therapy (1,149 patients), or the medical therapy alone (1,138 patients). They were followed-up for a median of 4.6 years.

In the percutaneous coronary intervention group, there were 211 primary events, compared with 202 events in the medical therapy group. In terms of deaths, myocardial infarctions and strokes, there were no significant differences between the two groups.

"Our findings reinforce existing clinical practice guidelines, which state that percutaneous coronary intervention can be safely deferred in patients with stable coronary artery disease, even in those with extensive, multivessel involvement and inducible ischemia, provided that intensive, multifaceted medical therapy is instituted and maintained," the authors conclude.

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