Author Affiliations: Division of Cardiology, Department of Medicine, Louisiana State University at Shreveport, Shreveport.
We read the recent meta-analysis by Drs Stergiopoulos and Brown1 comparing initial medical therapy with initial stent implantation for stable coronary artery disease (CAD) as well as the accompanying Invited Commentary by Dr Boden2 with great interest. However, we are concerned that the choice of trials does not support the conclusions arrived at. We agree with Dr Boden that any meta-analysis comparing optimal medical therapy (OMT) alone with OMT and percutaneous coronary intervention (PCI) in patients with stable CAD that fails to exclude both acute and post–myocardial infarction (MI) trials suffers from a significant methodological flaw.
Peter EA, Akkus NI, Varma J. Percutaneous Coronary Intervention for Stable Coronary Artery Disease: The Debate Continues. Arch Intern Med. 2012;172(13):1043-1044. doi:10.1001/archinternmed.2012.1753