OBJECTIVETo compare the impacts of percutaneous coronary intervention (PCI) and medical therapy on mortality in patients with stable coronary artery disease.

METHODSWe searched PubMed,Embase, Cochrane central register of controlled trials, Wanfang data and CNKI to find relevant randomized controlled trials on PCI versus medical therapy for treating patients with stable coronary artery disease, which were reported before December 2013. Publications were selected according to inclusion and exclusion standard. Meta-analyses was performed with the software of STATA 12.0.

RESULTSFive randomized controlled trials and 5 567 patients were enrolled for this analysis. Compared with medical therapy, PCI could not significantly decrease the long-term all-cause mortality (RR = 0.96, 95%CI 0.80-1.15), the cardiac death rate (RR = 1.02, 95%CI 0.77-1.36), the myocardial infarction rate (RR = 1.05, 95%CI 0.89-1.23), the acute coronary syndrome (RR = 0.70, 95%CI 0.27-1.82), the rate of freedom from angina (RR = 1.09, 95%CI 0.98-1.21), and the rate of stroke (RR = 1.27, 95%CI 0.75-2.15).However, the revascularization rate was significantly lower for patients in PCI group (RR = 0.60, 95%CI 0.42-0.86).

CONCLUSIONSLong-term mortality is similar for patients with stable coronary artery disease underwent PCI or medical therapy.

Angina Pectoris ; Coronary Artery Disease ; mortality ; therapy ; Coronary Disease ; Humans ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Randomized Controlled Trials as Topic ; Stroke

PURPOSE: Data comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris. MATERIALS AND METHODS: One hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke. RESULTS: Major adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041-5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035-0.703, p=0.016). CONCLUSION: Elective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.
Aged ; Aged, 80 and over ; Angina Pectoris/mortality/*therapy ; Coronary Stenosis/therapy ; Female ; Humans ; Male ; Myocardial Infarction/prevention & control/*therapy ; *Percutaneous Coronary Intervention ; Proportional Hazards Models ; Prospective Studies ; Republic of Korea ; Stroke/epidemiology ; Treatment Outcome

OBJECTIVETo examine long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA), coronary stenting and to assess the factors affecting its efficacy.

METHODSA total of 790 patients who underwent successful PTCA and PTCA + stent in this hospital were followed by direct interview or letter. The rate of follow-up was 84.2% and the period of follow-up was 0.9 - 12.7 (3.5 +/- 2.4) years.

RESULTSDuring follow-up, 4 (0.5%) patients died, 22 (2.8%) had nonfatal acute myocardial infarction, 10 (1.3%) had coronary artery bypass surgery, and 98 (12.4%) had repeat PTCA. The rate of recurrent angina pectoris was 31.1%. The cardiac event-free survival rate calculated by the Kaplan-Meier method was 88.2% at 1 year and 80.6% at 12.7 years. Cox regression analysis showed that there was a positive correlation between AMI history, stent implantation and the risk of cardiac events, and there was a negative correlation between the number of diseased arteries and the risk of cardiac events. Compared to the PTCA group, patients with PTCA + stent had significantly lower rates of total cardiac events.

CONCLUSIONThe long-term efficacy of PTCA, especially PTCA + stent in Chinese patients was very satisfactory, suggesting that PTCA + stent therapy should be the major treatment for revascularization in patients with coronary heart disease.

Adult ; Aged ; Angina Pectoris ; etiology ; Angioplasty, Balloon, Coronary ; adverse effects ; Coronary Stenosis ; mortality ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction ; etiology ; Retrospective Studies ; Stents ; adverse effects ; Survival Rate ; Treatment Outcome

BACKGROUN: Chief complaint is the primary history, quoted from patient, and the starting point of medical service. Physicians need to know what complaints are in the society and how they would be going. We to described what symptoms patients had, what diagnoses were made, and how was the mortality of patients admitted in Seoul National University Hosptial (SNUH) during the past 7 years (1991.1~1997.12). METHODS: In the past 7 years, 235,426 admitted cases were in SNUH. We computerized demographic factors, chief complaints, diagnoses at discharge, and mortality of patients. We categorized chief complaints as 93 major groups, dissected further with modifiers. The diagnoses were coded as ICD-10 and the mortality data was gathered through access to the annual police mortality data. We figured out the estimated mortality rate according to the chief complaint and/or diagnosis, using life table analysis through SSPS version 10.0. RESULTS: The most frequent chief complaint was pain, followed by chemotherapy, mass, dyspnea, bleeding and so on. Upper 20 symptom-groups occupied over 80 percents. We described specific symptoms, demographic factors, diagnoses, and rates of mortality in a certain chief complaint group. For example, abdominal pain, chest pain, lumbar pain, pain on lower extremity, and headache were seen frequently in the pain category. Symptom which had the worst prognosis was swallowing difficulty because almost half of patients with it had malignancy. We showed descriptive data of liver cirrosis, diabetes mellitus, angina pectoris, chronic renal failure, and pulmonary tuberculosis. For example, we found the painless angina pectoris had worse prognosis than the painful cases. We also discussed the usefulness of these data to education, medical service, medical research, and quality improvement in medicine. CONCLUSION: We figured out clinically important chief complaints, their diagnoses, and their mortality rate of patients admitted in SNUH. We hope nation-wide survey like this study would be planned in near future. We could use it's data in many fields, such as educational renovation, medical reseasrch, medical quality control and so on.
Abdominal Pain ; Angina Pectoris ; Chest Pain ; Deglutition ; Demography ; Diabetes Mellitus ; Diagnosis* ; Drug Therapy ; Dyspnea ; Education, Medical ; Headache ; Hemorrhage ; Hope ; Humans ; International Classification of Diseases ; Kidney Failure, Chronic ; Life Tables ; Liver ; Lower Extremity ; Mortality* ; Police ; Prognosis ; Quality Control ; Quality Improvement ; Seoul* ; Tuberculosis, Pulmonary