Revascularisation for patients with stable coronary artery disease

There is strong evidence that percutaneous coronary interventions (PCI) reduce the risk of myocardial infarction and death among patients with acute coronary syndromes. However, these benefits have not been established for patients with stable coronary artery disease. For such patients, PCI relieves angina and improves quality of life, but studies have found no evidence that the procedure reduces mortality or risk of myocardial infarction compared with the best medical treatment.1 Emphasis on the limited role of PCI for patients with stable disease may have contributed to a decrease in its use in recent years.

In a linked paper (doi:10.1136/bmj.g3859) Windecker and colleagues2 report the results of a meta-analysis to compare the outcomes of patients with stable disease who were assigned to initial medical treatment or to medical treatment plus coronary artery revascularisation. Importantly, given the evolution of percutaneous devices and as a result changing comparator treatments (see fig 1 in the linked paper), a network based analysis was needed to identify potential sequential changes over time. The analysis incorporated data from over 93 000 patients randomised in 100 trials …