Research news: April 2012
Arch Intern Med2012;172:312-9
Each year, around 400 000 US adults with stable angina have a percutaneous coronary intervention (PCI), despite increasing evidence that this procedure does not prolong survival, prevent heart attacks, or improve symptoms more than medical treatment alone. A new meta-analysis confined to trials that compared modern percutaneous coronary interventions with modern drug protocols confirms that PCI, including stenting, does not benefit adults with stable coronary artery disease.
The authors and a linked editorial agree that the US has a problem (p 319). While the government and funding agencies push hard for large comparative effectiveness trials, providers are busy ignoring the results, wilfully or otherwise. They must be persuaded to change direction, says the editorial. Guidelines already recommend best medical treatment first. Averting or deferring even a third of elective PCIs in stable patients would save the health economy between $6bn (£3.8bn; €4.5bn) and $8bn a year.