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Editor's Correspondence
July 9, 2012

Stenting vs Medical Therapy for Stable Coronary Artery Disease: A Minefield for Meta-analyses?—Reply

Author Affiliations

Author Affiliations: Department of Medicine (Cardiovascular Medicine), Stony Brook University Medical Center, Stony Brook, New York.

Arch Intern Med. 2012;172(13):1044-1045. doi:10.1001/archinternmed.2012.2215

In reply

Regarding the comments by Peter and colleagues, we compared therapeutic strategies in patients with stable coronary artery disease (CAD), not stable angina. Our definition of stable CAD included not only patients with stable angina or ischemia but also stable patients with recent myocardial infarction (MI), occluded infarct-related arteries, and no evidence of ischemia and hemodynamic or electrical instability. We agree that this definition allowed for the inclusion of 2 different patient populations, but it would be inappropriate to exclude studies post hoc. Nevertheless, we performed subgroup analysis on the 5 stable angina or ischemia studies and the 3 post-MI studies. As was stated in our article,1 this subgroup analysis demonstrated no significant differences between the 2 groups of studies with regard to death, revascularization, or persistent angina. A strategy of initial percutaneous coronary intervention in the post-MI studies was associated with a significantly increased risk of subsequent MI, which was not seen in the stable angina/ischemia trials.

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