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Editor's Correspondence
June 26, 2006

Good Outcomes in Coronary Artery Disease Without Invasive Procedures

Arch Intern Med. 2006;166(12):1325. doi:10.1001/archinte.166.12.1325-a

Nash convincingly demonstrates that for chronic stable coronary artery disease, invasive procedures afford no mortality benefit compared with medical treatment.1 He credits Forrester and Shah2 with having noted this fact in 1997, ignoring that already a quarter of a century earlier we had demonstrated exceptional survival with a paucity of hard cardiovascular end points for medically treated patients with coronary heart disease.3,4 It needs to be recalled that at the time key pharmaceutical agents, especially statin drugs, were unavailable. Results were significantly improved in a recently reported larger study from our group involving 693 patients with coronary heart disease.5 The annual incidence of nonfatal myocardial infarction, cardiac mortality, and total mortality was 2.2%, 0.8%, and 1.4%, respectively, during an average follow-up of 4.6 years.

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