Los stent coronarios sin beneficios en cardiopatía isquémica estable

Foro general ciencia, medicina, nutrición, salud pública, política

Moderador: Fisio

Los stent coronarios sin beneficios en cardiopatía isquémica estable

Notapor Fisio » Sab, 24 May 2014, 17:32

Seguimos con tratamientos médicos realizados sin ningún tipo de beneficio ni evidencia. Los stent coronarios sin beneficios en cardiopatía isquémica estable.

Initial Coronary Stent Implantation With Medical Therapy vs Medical Therapy Alone for Stable Coronary Artery DiseaseMeta-analysis of Randomized Controlled Trials FREE
Kathleen Stergiopoulos, MD, PhD; David L. Brown, MD

Background Prior meta-analyses have yielded conflicting results regarding the outcomes of treatment of stable coronary artery disease (CAD) with initial percutaneous coronary intervention (PCI) vs medical therapy. However, most of the studies in prior systematic reviews used balloon angioplasty as well as medical therapies that do not reflect current interventional or medical practices. We therefore performed a meta-analysis of all randomized clinical trials comparing initial coronary stent implantation with medical therapy to determine the effect on death, nonfatal myocardial infarction (MI), unplanned revascularization, and persistent angina.

Methods Prospective randomized trials were identified by searches of the MEDLINE database from 1970 to September 2011. Trials in which stents were used in less than 50% of PCI procedures were excluded. Data were extracted from each study, and summary odds ratios (ORs) were obtained using a random effects model.

Results Eight trials enrolling 7229 patients were identified. Three trials enrolled stable patients after MI, whereas 5 studies enrolled patients with stable angina and/or ischemia on stress testing. Mean weighted follow-up was 4.3 years. The respective event rates for death with stent implantation and medical therapy were 8.9% and 9.1% (OR, 0.98; 95% CI, 0.84-1.16); for nonfatal MI, 8.9% and 8.1% (OR, 1.12; 95% CI, 0.93-1.34); for unplanned revascularization, 21.4% and 30.7% (OR, 0.78; 95% CI, 0.57-1.06); and for persistent angina, 29% and 33% (OR, 0.80; 95% CI, 0.60-1.05).

Conclusion Initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death, nonfatal MI, unplanned revascularization, or angina.

Percutaneous coronary intervention (PCI) reduces death and nonfatal myocardial infarction (MI) in the setting of acute coronary syndromes.1,2 However, the role of PCI in treatment of stable coronary artery disease (CAD) remains controversial.3,4 Despite recent studies clearly demonstrating that initial PCI offers no benefit in terms of reducing death or other cardiovascular events over optimal medical therapy in the setting ofnonacute CAD,5- 7 these findings have not been incorporated into clinical practice.8,9 Perhaps contributing to the ambiguity, recent meta-analyses have yielded conflicting results regarding the impact of PCI on survival of patients with stable CAD.10,11 These meta-analyses included studies that enrolled patients in the 1980s and 1990s, an era when balloon angioplasty was the predominant form of PCI. Since that time, interventional practice has evolved toward the placement of coronary stents whenever technically feasible to prevent acute vessel closure and restenosis. Medical therapy has advanced over the last 20 years as well. For example, medical treatment in the Angioplasty Compared with Medicine (ACME) trial,12 which enrolled patients from 1987 to 1990 included aspirin, nitrates, β-blockers, and calcium channel blockers12 but did not include 3-hydroxy-3-methylglutaryl co-enzyme-A reductase inhibitors (statins), angiotensin-converting enzyme (ACE) inhibitors, or angiotensin receptor blockers, which are now considered essential components of optimal medical therapy.13 We therefore performed a systematic review and meta-analysis of randomized clinical trials that compared initial stent implantation and medical therapy with a strategy of initial medical therapy alone to determine the effect of contemporary interventional and medical therapy on outcomes of patients with stable CAD.


http://archinte.jamanetwork.com/article ... id=1108733
Avatar de Usuario
Fisio
Administrador del Sitio
 
Mensajes: 6215
Registrado: Dom, 01 Sep 2013, 14:18

Re: Los stent coronarios sin beneficios en cardiopatía isquémica estable

Notapor Fisio » Sab, 24 May 2014, 17:34

Y produciendo muertes

Deaths Linked to Cardiac Stents Rise as Overuse Seen

http://www.bloomberg.com/news/2013-09-2 ... -seen.html
Avatar de Usuario
Fisio
Administrador del Sitio
 
Mensajes: 6215
Registrado: Dom, 01 Sep 2013, 14:18


Volver a Muscleblog

¿Quién está conectado?

Usuarios navegando por este Foro: Fisio, ZeRaTuL y 2 invitados