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Percutaneous coronary intervention for stable coronary artery disease

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Title: Percutaneous coronary intervention for stable coronary artery disease
Authors: Al-Lamee, RK
Nowbar, AN
Francis, DP
Item Type: Journal Article
Abstract: The adverse consequences of stable coronary artery disease (CAD) are death, myocardial infarction (MI) and angina. Trials in stable CAD show that percutaneous coronary intervention (PCI) does not reduce mortality. PCI does appear to reduce spontaneous MI rates but at the expense of causing some periprocedural MI. Therefore, the main purpose of PCI is to relieve angina. Indeed, patients and physicians often choose PCI rather than first attempting to control symptoms with anti-anginal medications as recommended by guidelines. Nevertheless, it is unclear how effective PCI is at relieving angina. This is because, whereas anti-anginal medications are universally required to be tested against placebo, there is no such requirement for procedural interventions such as PCI. The first placebo-controlled trial of PCI showed a surprisingly small effect size. This may be because it is overly simplistic to assume that the presence of a stenosis and inducible ischaemia in a patient means that the clinical chest pain they report is caused by ischaemia. In this article, we review the evidence base and argue that if we as a medical specialty wish to lead the science of procedures for symptom control, we should recognise the special merit of placebo-controlled experiments.
Issue Date: 1-Jan-2019
Date of Acceptance: 22-Aug-2018
URI: http://hdl.handle.net/10044/1/64144
DOI: https://dx.doi.org/10.1136/heartjnl-2017-312755
ISSN: 1355-6037
Publisher: BMJ Publishing Group
Start Page: 11
End Page: 19
Journal / Book Title: Heart
Volume: 105
Copyright Statement: © Author(s) (or their employer(s)) 2018. No commercial re-use. This article has been accepted for publication in Heart following peer review. The definitive copyedited, typeset version is available online at: https://dx.doi.org/10.1136/heartjnl-2017-312755
Keywords: chronic coronary disease
percutaneous coronary intervention
1102 Cardiovascular Medicine And Haematology
Cardiovascular System & Hematology
Publication Status: Published
Conference Place: England
Online Publication Date: 2018-09-21
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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