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Percutaneous Coronary Intervention Plus Medical Therapy Reduces the Incidence of Acute Coronary Syndrome More Effectively Than Initial Medical Therapy Only Among Patients With Low-Risk Coronary Artery Disease

A Randomized, Comparative, Multicenter Study

Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Gifu City, Gifu, Japan

^_* Reprint requests and correspondence: Dr. Hisayoshi Fujiwara, Chair of JSAP Study, Second Department of Internal Medicine, Gifu University Graduate School of Medicine, Yanagido 1-1, Gifu City, Gifu, 501-1194, Japan (Email: gifuim-gif{at}umin.ac.jp).

Objectives: This study sought to determine whether initial medical therapy (MT) only or percutaneous coronary intervention plus medical therapy (PCI+MT) is better for patients with low-risk stable coronary artery disease (CAD) indicated for intervention in Japan.

Background: Several multicenter studies have suggested that in the above patients, an initial management strategy of PCI+MT does not reduce the long-term risk of cardiovascular events more effectively than initial MT only.

Methods: We conducted a randomized comparative study (JSAP [Japanese Stable Angina Pectoris] study) in the previously mentioned patients.

Results: The patients were randomized to PCI+MT (n = 192) or initial MT only group (n = 192), and the patient characteristics were very similar in the 2 groups. During the 3.3-year follow-up, there was no significant difference in the cumulative death rate between PCI+MT (2.9%) and MT (3.9%). However, the cumulative risk of death plus acute coronary syndrome was significantly smaller in PCI+MT.

Conclusions: In stable low-risk CAD, PCI+MT may improve long-term prognosis more effectively than MT.

Key Words: angina pectoris • randomized trial • long-term prognosis

Abbreviations and Acronyms   ACS = acute coronary syndrome   AMI = acute myocardial infarction   CAD = coronary artery disease   CAG = coronary arteriography   CI = confidence interval   CVA = cerebrovascular accidents   ECG = electrocardiogram   LAD = left anterior descending artery   MT = medical therapy   PCI = percutaneous coronary intervention   UAP = unstable angina pectoris

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