martedì 27 marzo 2007

PTCA si o no ?



E' utile l'angioplastica nei pazienti con cardiopatia ischemica e terapia medica ottimale ?
Un ampio studio pubblicato sul NEJM non sembra avvalorare questa ipotesi. Nello studio sono stati arruolati 2300 pazienti e inviati o al gruppo terapia medica (con interveti sullo stile di vita) o al gruppo PTCA con terapia medica successiva. I risultati a 5 anni non hanno evidenziato un sostanziale beneficio in termini di sopravvivenza e di eventi cardiaci maggiori (circa 18% in entrambi i gruppi).
Qui l'articolo gratuito.

PCI Fails to Provide Additional Benefit in Stable Patients on Optimal Medical Therapy

PCI does not lower the rates of myocardial infarction or death in patients with stable coronary artery disease who receive optimal medical treatment, a large trial concluded.

The study, released early online by NEJM, randomized nearly 2300 patients either to PCI with optimal medical therapy (intensive pharmacologic treatment plus lifestyle intervention) or to optimal medical therapy alone. After a median follow-up of almost 5 years, 19% in the PCI group died or had MIs, compared with 18.5% who received medical therapy alone.

PCI patients were more likely to be free of angina after 1 and 3 years, but there was no significant difference after 5 years. One-third of patients in the medical therapy group ultimately required revascularization, while 21% in the PCI group needed additional revascularization.

An editorialist concludes: "Patients whose condition is clinically unstable, who have left main coronary artery disease, or in whom medical therapy has failed to control symptoms remain candidates for revascularization, but PCI should not play a major role as part of a secondary prevention strategy."
(da Journal watch)

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