Comparison Between Percutaneous Coronary Intervention and Medical Treatment in the Management of Egyptian Patients With Chronic Coronary syndrome: A Randomized Controlled Trial

Background:Although the role of percutaneous coronary intervention (PCI) as an initial strategy in the management of chronic coronary syndrome (CCS) remains debatable, the current evidence recommends intensive medical treatment as first-line therapy, with PCI reserved for those who remain symptomatic. Purpose:This study evaluated the midterm (up to 6 months) outcomes of PCI versus optimal medical therapy (OMT) alone in patients with CCS. Materials and methods:Two hundred ten patients with CCS and >70% lesion involving one or more coronary arteries were equally randomized (1:1) to one of two groups: 105 patients underwent PCI with OMT and 105 patients were assigned to OMT alone. All patients were followed up for 6 months for the occurrence of major adverse cardiac events and the improvement in symptoms and exercise capacity. Results:There was no statistically significant difference between PCI and medical-therapy regarding the primary end point after 6 months of follow-up. Both groups showed improvement in anginal symptoms, although greater improvement was observed in the PCI group (P < .001). The increment of distance in a 6-minute walk test in the two groups was significant, which is higher in the PCI group (P < .001). The improvement in Seattle Angina Questionnaire score and the improvement in quality of life (assessed by the EQ-5D-5L score) in the two groups were statistically significant, which are higher in the PCI group (P < .001 for each). Conclusion:PCI had no added prognostic value over OMT in patients with CCS. However, the ability of PCI to improve symptoms was more rapid and more effective than OMT.