CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Albert Schömig, MD* and
Adnan Kastrati, MD
* Deutsches Herzzentrum, Lazarettstr. 36, Munich, Bavaria 80636, Germany (Email: aschoemig{at}dhm.mhn.de).
We thank Dr. Arbab-Zadeh for his interest in our paper (1). The title and the content of his letter show that he misinterprets the essence of our meta-analysis (1) by considering it as a direct competition between percutaneous coronary intervention (PCI) and drug therapy. In the Discussion section of our article (1), we warned against the risk of this kind of misinterpretation by writing: "It is important to note that the included randomized trials, and consequently the entire present meta-analysis, should not be considered as a head-to-head comparison of 2 mutually exclusive treatment strategies. On the contrary, all of them evaluated the value of the PCI-based strategy as an addition to medical therapy, because patients in both study arms received medical treatment." We also acknowledged that advances in both pharmacological and interventional treatment of patients with coronary artery disease may have an impact, although the year of completion of patient enrollment did not have a significant influence on the overall result as shown by the meta-regression analysis.
The unique contribution of our meta-analysis was the ability to assess the impact of PCI on mortality, for which assessment, none of the individual trials, including the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, had sufficient power. Obviously, the performance of a new, large randomized trial with mortality as primary end point is more than welcome; but, until then, the results of our meta-analysis are the best available evidence on this topic and should help in guiding the treatment of patients with stable coronary artery disease.
As interventional cardiologists, we have recognized the great clinical benefits achieved with pharmacological therapy in patients with stable coronary artery disease. We prescribe the drugs mentioned in the letter of Dr. Arbab-Zadeh to almost all patients prior to and after PCI. We closely work with noninterventional cardiologists to provide optimal pharmacological and PCI-based treatment to patients with stable coronary artery disease. However, the benefit to these patients will be maximized if the merits of PCI are duly recognized by the physicians who take care of patients with stable coronary artery disease.
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References
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1. Schömig A, Mehilli J, de Waha A, Seyfarth M, Pache J, Kastrati A. A meta-analysis of 17 randomized trials of a percutaneous coronary intervention-based strategy in patients with stable coronary artery disease J Am Coll Cardiol 2008;52:894-904.[Abstract/Free Full Text]
Related Article
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Medical Therapy Versus Percutaneous Coronary Intervention for Patients With Stable Coronary Artery Disease
- Armin Arbab-Zadeh
J. Am. Coll. Cardiol. 2009 53: 528-529.
[Full Text]
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