Angioplasty or Medication-Only Therapy for Angina – Which is Best? By Paula Rasich Reviewed by Elizabeth Klodas, MD, FACC (CardioSmart) People living with angina (chest pain) or other symptoms of coronary artery disease can be treated with medications and/or angioplasty.  Angioplasty, now more commonly referred to as PCI (percutaneous coronary intervention) may involve balloon expansion of a blockage in a coronary artery or the implantation of one or more stents to hold the artery open.  In general, there is still debate whether medications or PCI should be used for patients with angina and which approach is associated with better outcomes.

A new meta-analysis of 17 randomized trials suggests that patients may indeed do better in the long-term if they choose angioplasty over drug treatment alone,                  

In the pooled study involving 7,513 people with coronary artery disease, a team of German scientists led by Albert Schomig, MD, of the Technische Universitat in Munich, compared the outcomes of patients who were treated with PCI or medication-only therapy to relieve symptoms of ischemia (restricted blood flow to the heart). Nearly half of the study population got one of the two different treatments.  Medication therapy could include cholesterol-lowering statins, blood thinners, beta blockers (which slow heart rate and lower blood pressure), or ACE inhibitors (medications which lower blood pressure and appear to affect plaque stability).

When researchers reviewed the data they found that during an average follow up period of about four years, 606 deaths occurred, with 271 happening in the angioplasty group, and 335 in the medication-only group.  This represents a 20% reduction in risk of overall death in the PCI group.  The study authors concluded that “these findings suggest that a PCI-based invasive strategy [angioplasty and/or stent implantation] may improve long-term survival as compared with a medical treatment-only strategy in patients with stable coronary artery disease.”

A major limitation of this analysis is the inclusion of data from trials published as far back as 1993, therefore including treatment strategies (on both sides) which are no longer current.  Although not based on as many patients, more recent trial data has suggested that optimal medical therapy is at least equivalent to PCI in terms of outcome.

In an accompanying editorial, Robert A. O’Rourke, MD, a cardiologist in private practice in San Antonio, Texas, recommends “more aggressive medical therapy for patients with moderate to severe angina, and PCI or CABG [coronary artery bypass graft surgery] for patients whose symptoms persist.”

Certainly, patients have options in terms of treatment.  And the options are not necessarily mutually exclusive.  The potential benefits and risks of all treatment options should be discussed with your doctor.

The study is published in the September 9, 2008 issue of the Journal of the American College of Cardiology.

Sources:

Schomig A. et al.  A Meta-Analysis of 17 Randomized Trials of a Percutaneous Coronary Intervention-Based Strategy in Patients With Stable Coronary Artery Disease.  Journal of the American College of Cardiology, 2008.

O’Rourke RA. Optimal Medical Therapy Is a Proven Option for Chronic Stable Angina: Editorial Commentary. Journal of the American College of Cardiology, 2008.