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Role of percutaneous coronary intervention in the modern-day management of chronic coronary syndrome

Lookup NU author(s): Professor Vijay KunadianORCiD

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Abstract

© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.Contemporary randomised trials of percutaneous coronary intervention (PCI) in chronic coronary syndrome (CCS) demonstrate no difference between patients treated with a conservative or invasive strategy with respect to all-cause mortality or myocardial infarction, although trials lack power to test for individual endpoints and long-term follow-up data are needed. Open-label trials consistently show greater improvement in symptoms and quality of life among patients with stable angina treated with PCI. Further studies are awaited to clarify this finding. In patients with severe left ventricular (LV) systolic dysfunction and obstructive coronary artery disease in the Revascularization for Ischemic Ventricular Dysfunction trial, PCI has not been found to improve all-cause mortality, heart failure hospitalisation or recovery of LV function when compared with medical therapy. PCI was, however, performed without additional hazard and so remains a treatment option when there are favourable patient characteristics. The majority of patients reported no angina, and the low burden of angina in many of the randomised PCI trials is a widely cited limitation. Despite contentious evidence, elective PCI for CCS continues to play a significant role in UK clinical practice. While PCI for urgent indications has more than doubled since 2006, the rate of elective PCI remains unchanged. PCI remains an important strategy when symptoms are not well controlled, and we should maximise its value with appropriate patient selection. In this review, we provide a framework to assist in critical interpretation of findings from most recent trials and meta-analysis evidence.

Publication metadata

Author(s): Cartlidge T, Kovacevic M, Navarese EP, Werner G, Kunadian V

Publication type: Review

Publication status: Published

Journal: Heart

Year: 2023

Volume: 109

Issue: 19

Pages: 1429-1435

Online publication date: 16/03/2023

Acceptance date: 06/03/2023

ISSN (print): 1355-6037

ISSN (electronic): 1468-201X

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/heartjnl-2022-321870

DOI: 10.1136/heartjnl-2022-321870

PubMed id: 36928242

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