Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials

doi:10.1136/bmj.321.7253.73

BMJ 2000;321:73-77 ( 8 July )

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Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomised controlled trials

Editorial by Lüscher

Heiner C Bucher, assistant professor, ^a Peter Hengstler, senior fellow, ^a Christian Schindler, statistician, ^b Gordon H Guyatt, professor. ^c

^a Medizinische Universitäts-Poliklinik, Kantonsspital Basel, CH-4031 Basle, Switzerland, ^b Institut für Sozial-und Präventivmedizin, Basle University, Switzerland, ^c Department for Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada L8N 3Z5

Correspondence to: H Bucher hbucher{at}uhbs.ch

Objective: To determine whether percutaneous transluminalcoronary angioplasty (angioplasty) is superior to medical treatmentin non-acute coronary arterydisease.
Design: Meta-analysis of randomised controlledtrials.
Setting: Randomised controlled trials conducted worldwideand published between 1979 and1998.
Participants: 953 patients treated with angioplasty and951 with medical treatment from six randomised controlled trials,three of which included patients with multivessel disease andpre-existing myocardialinfarction.
Main outcome measures: Angina, fatal and non-fatal myocardial infarction,death, repeated angioplasty, and coronary artery bypassgrafting.
Results: In patients treated with angioplasty comparedwith medical treatment the risk ratios were 0.70 (95% confidenceinterval 0.50 to 0.98; heterogeneity P<0.001) for angina; 1.42(0.90 to 2.25) for fatal and non-fatal myocardial infarction,1.32 (0.65 to 2.70) for death, 1.59 (1.09 to 2.32) for coronaryartery bypass graft, and 1.29 (0.71 to 3.36; heterogeneity P<0.001)for repeated angioplasty. Differences in the methodological qualityof the trials, in follow up, or in single versus multivessel diseasedid not explain the variability in study results in anyanalysis.
Conclusions: Percutaneous transluminal coronary angioplastymay lead to a greater reduction in angina in patients with coronaryheart disease than medical treatment but at the cost of more coronaryartery bypass grafting. Trials have not included enough patientsfor informative estimates of the effect of angioplasty on myocardialinfarction, death, or subsequent revascularisation, though trendsso far do not favourangioplasty.

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