PCI reduced risk for spontaneous MIs compared with OMT
Compared with optimal medical therapy, PCI was associated with reduced risk for spontaneous MI and increased the risk for more procedural MI, with no effect observed on all-cause MI, according to a meta-analysis.
Researchers of the analysis considered results from 12 randomized controlled trials published as recently as October 2012 comprising 37,548 patient-years of follow-up that compared PCI with optimal medical therapy (OMT) for stable ischemic heart disease.
When compared with OMT, PCI was associated with a lower incident rate ratio (IRR) for spontaneous non-procedural MI (IRR=0.76; 95% CI, 0.58-0.99) at the risk of higher procedural MI (IRR=4.11; 95% CI, 2.53-6.88).
Regarding all-cause MI, there was no difference between PCI and OMT (event rate, 18.28 vs. 18.31 per 1,000 patient-years; IRR=0.96; 95% CI, 0.74-1.21).
This study and previous ones suggest that spontaneous non-procedure related MI is prognostically more important, Sripal Bangalore, MD, of New York University School of Medicine, and fellow researchers said.
“It is increasingly clear that the prognostic impact of procedural MI is not the same as that of spontaneous MI, and combining both in the ‘any MI’ definition, especially in trials of PCI vs. OMT, is problematic,” Bangalore and colleagues wrote.
Disclosure: The researchers report no relevant financial disclosures.