Revascularization Not Linked with Decreased Mortality Risk in Some Patients: Analysis

Revascularization, a commonly used intervention for patients with stable ischemic heart disease, was not linked with a decrease in mortality risk in patients with stable ischemic heart disease, a new analysis suggests.

“Revascularization is often performed in patients with stable ischemic heart disease (SIHD),” the authors wrote. “However, whether revascularization reduces death and other cardiovascular outcomes is uncertain.”

The group accessed PUBMED/EMBASE/CENTRAL database searches looking for randomized clinical trials comparing revascularization versus an initial conservative strategy in those with stable ischemic heart disease. The primary study outcome of interest was death, and secondary outcomes included cardiovascular death, myocardial infarction, heart failure, stroke, unstable angina, and freedom from angina. In order to evaluate outcomes in contemporary trials, the authors stratified the trials by percent stent use and percent statin use.

The authors identified 14 randomized controlled trials that included more than 14,800 patients who were followed out to a mean of 4.5 years (64,678 patient-years of follow-up). According to the results, revascularization was not associated with a reduction in the risk for death when compared with medical therapy alone (RR=0.99; 95% CI, 0.90 to 1.09). It was also associated with both reduced non-procedural myocardial infarction, and also procedural-related myocardial infarction; there was no difference in myocardial infarction overall (RR=0.93; 95% CI, 083 to 1.03). Revascularization was associated with a significant reduction in unstable angina and increased freedom from angina. No treatment-related differences were reported in the risk of heart failure or stroke.

“In patients with stable ischemic heart disease, routine revascularization was not associated with improved survival, but was associated with a lower risk of non-procedural myocardial infarction and unstable angina with greater freedom from angina at the expense of higher rates of procedural myocardial infarction,” the authors wrote. “Longer-term follow-up of trials is needed to assess whether reduction in these non-fatal spontaneous events improves long-term survival.”

The paper was published in Circulation.