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Percutaneous coronary intervention plus medical therapy versus medical therapy alone in chronic coronary syndrome : a propensity score-matched analysis from the Swedish Coronary Angiography and Angioplasty Registry

von Koch, Sacharias LU orcid ; Koul, Sasha LU ; Grimfjärd, Per ; Andersson, Jonas ; Jernberg, Tomas ; Omerovic, Elmir ; Fröbert, Ole ; Erlinge, David LU orcid and Mohammad, Moman A. LU orcid (2024) In Heart 110(22). p.1307-1315
Abstract

Background Percutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone. Methods We conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio... (More)

Background Percutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone. Methods We conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio analysis, a statistical method that ranks the components of the composite by clinical importance. The primary outcome was net adverse clinical event (NACE) within 5 years. In the win ratio analysis, the components of NACE were ranked as follows: (1) all-cause mortality, (2) myocardial infarction (MI), (3) bleeding and (4) urgent revascularisation. Secondary outcomes were the individual components of NACE, major adverse cardiovascular events (MACE) and cardiovascular mortality. Results After PS matching, two groups of 7220 patients each were formed. The hierarchical outcome analysis of NACE and MACE showed that PCI was associated with improved outcome (matched win ratio: 1.28 (95% CI 1.20 to 1.36, p<0.001) and matched win ratio: 1.38 (95% CI 1.29 to 1.48, p<0.001), respectively). The use of PCI was associated with higher win ratio of MI (matched win ratio: 1.15, 95% CI 1.04 to 1.28, p=0.008), urgent revascularisation (matched win ratio: 1.85, 95% CI 1.69 to 2.03, p<0.001) and cardiovascular mortality (matched win ratio: 1.15, 95% CI 1.00 to 1.34, p=0.044). No difference in win ratio was observed for all-cause mortality or bleeding. Conclusions In this study, which sought to evaluate the outcomes of patients with CCS using a hierarchical approach, patients selected for revascularisation with PCI experienced better outcome compared with MT alone.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Angina Pectoris, Atherosclerosis, Cardiovascular Diseases, Percutaneous Coronary Intervention, Pharmacology, Clinical
in
Heart
volume
110
issue
22
pages
1307 - 1315
publisher
BMJ Publishing Group
external identifiers
  • pmid:39214681
  • scopus:85204036589
ISSN
1355-6037
DOI
10.1136/heartjnl-2024-324307
language
English
LU publication?
yes
id
2fe7a456-4ff6-46d3-b66f-652921077e7c
date added to LUP
2024-11-27 12:04:41
date last changed
2025-01-22 17:06:53
@article{2fe7a456-4ff6-46d3-b66f-652921077e7c,
  abstract     = {{<p>Background Percutaneous coronary intervention (PCI) is frequently used for patients with chronic coronary syndrome (CCS). However, the role of PCI beyond symptom relief in CCS remains controversial. The objective of this study was to determine whether PCI is associated with better outcomes, compared with medical therapy (MT) alone. Methods We conducted a retrospective cohort study. Using the Swedish Coronary Angiography and Angioplasty Registry, we included all patients with CCS undergoing coronary angiography in Sweden between 2010 and 2020. Two groups were formed based on treatment strategy: PCI+MT versus MT alone. One-to-one propensity score (PS) matching was used to address confounding. Outcome was assessed using matched win ratio analysis, a statistical method that ranks the components of the composite by clinical importance. The primary outcome was net adverse clinical event (NACE) within 5 years. In the win ratio analysis, the components of NACE were ranked as follows: (1) all-cause mortality, (2) myocardial infarction (MI), (3) bleeding and (4) urgent revascularisation. Secondary outcomes were the individual components of NACE, major adverse cardiovascular events (MACE) and cardiovascular mortality. Results After PS matching, two groups of 7220 patients each were formed. The hierarchical outcome analysis of NACE and MACE showed that PCI was associated with improved outcome (matched win ratio: 1.28 (95% CI 1.20 to 1.36, p&lt;0.001) and matched win ratio: 1.38 (95% CI 1.29 to 1.48, p&lt;0.001), respectively). The use of PCI was associated with higher win ratio of MI (matched win ratio: 1.15, 95% CI 1.04 to 1.28, p=0.008), urgent revascularisation (matched win ratio: 1.85, 95% CI 1.69 to 2.03, p&lt;0.001) and cardiovascular mortality (matched win ratio: 1.15, 95% CI 1.00 to 1.34, p=0.044). No difference in win ratio was observed for all-cause mortality or bleeding. Conclusions In this study, which sought to evaluate the outcomes of patients with CCS using a hierarchical approach, patients selected for revascularisation with PCI experienced better outcome compared with MT alone.</p>}},
  author       = {{von Koch, Sacharias and Koul, Sasha and Grimfjärd, Per and Andersson, Jonas and Jernberg, Tomas and Omerovic, Elmir and Fröbert, Ole and Erlinge, David and Mohammad, Moman A.}},
  issn         = {{1355-6037}},
  keywords     = {{Angina Pectoris; Atherosclerosis; Cardiovascular Diseases; Percutaneous Coronary Intervention; Pharmacology, Clinical}},
  language     = {{eng}},
  number       = {{22}},
  pages        = {{1307--1315}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{Heart}},
  title        = {{Percutaneous coronary intervention plus medical therapy versus medical therapy alone in chronic coronary syndrome : a propensity score-matched analysis from the Swedish Coronary Angiography and Angioplasty Registry}},
  url          = {{http://dx.doi.org/10.1136/heartjnl-2024-324307}},
  doi          = {{10.1136/heartjnl-2024-324307}},
  volume       = {{110}},
  year         = {{2024}},
}