Perkutane Koronarintervention zusätzlich zu optimaler medikamentöser Therapie bei stabiler koronarer Herzkrankheit

Zusammenfassung

Fragestellung: Die vorliegende Arbeit untersucht den Stellenwert einer perkutanen Koronarintervention (PCI) zusätzlich zu optimaler medikamentöser Therapie bei stabiler koronarer Herzkrankheit (KHK).

Methodik: Es wurden eine systematische Literaturrecherche in Onlinedatenbanken MEDLINE, EMBASE etc. im Juni 2010, eine Update-Recherche in MEDLINE im Februar 2013 und eine Handsuche durchgeführt. Randomisierte kontrollierte Studien (RCT) und systematische Übersichten von RCT zum Vergleich PCI vs. keine PCI bei stabiler KHK wurden identifiziert und ausgewertet. Ergebnisse für Tod, Myokardinfarkt sowie Angina Pectoris aus den RCT mit Anwendung einer optimalen medikamentösen Therapie wurden mithilfe einer Meta-Analyse für das relative Risiko (RR) zusammengefasst. Die Aussagekraft der Evidenz wurde in Anlehnung an GRADE bewertet.

Ergebnisse: Nach Bewertung von 7 systematischen Übersichten und 23 RCT wurden 4 RCT mit Anwendung einer optimalen medikamentösen Therapie (Beta-Blocker, ASS, Statine bei über 80% sowie ACE-Hemmer bei über 50% der Patienten in der Studie) identifiziert. Das Risiko für Tod und das Risiko für Myokardinfarkt waren bis 5 Jahre nach Therapiebeginn nicht signifikant unterschiedlich zwischen den Alternativen. PCI reduzierte den Anteil von Patienten mit Angina-Pectoris-Anfällen bis 3 Jahre nach Therapiebeginn (RR  0,81; 95 %-KI 0,71–0,92). Die Aussagekraft der Evidenz wurde als moderat eingestuft.

Folgerung: Eine PCI zusätzlich zur optimalen medikamentösen Therapie bei stabiler KHK sollte zur Reduktion des Anteils von Patienten mit Angina-Pectoris-Anfällen bis 3 Jahre nach Therapiebeginn führen.

Abstract

Objective: We evaluated the effect of percutaneous coronary interventions (PCI) in addition to optimal medical therapy in stable coronary artery disease (CAD).

Methods: A systematic literature search was conducted in the online databases MEDLINE, EMBASE etc. in June 2010, updated in February 2013 in MEDLINE and completed by a hand search. Randomized controlled trials (RCT) and systematic reviews of RCT comparing PCI vs. no PCI in stable CAD  were identified and evaluated. Results for death, myocardial infarction and angina pectoris of the RCTs using optimal medical therapy were combined with meta-analysis for relative risk (RR). The strength of the evidence was appraised based on GRADE.

Results: After evaluation of 7 systematic reviews and 23 RCT 4 RCTs using optimal medical therapy (Betablockers, ASS, Statins in more than 80% and ACE-Inhibitors in more than 50% of patients the study) were identified. No significant difference was found for the risks of death and of myocardial infarction between the alternatives up to 5 years after beginning the therapy. The PCI reduced the proportion of patients with angina pectoris attacks up to 3 years after beginning the therapy, RR = 0,81 (95 % CI: 0,71 to 0,92). The strength of the evidence was appraised as moderate.

Conclusion: The use of PCI in addition to optimal medical therapy in stable CAD  may reduce the proportion of patients with angina pectoris attacks up to 3 years after beginning the therapy.

Schlüsselwörter

stabile koronare Herzkrankheit - perkutane Koronarintervention - optimale medikamentöse Therapie - systematische Übersicht - Meta-Analyse

Keywords

stable coronary artery disease - percutaneous coronary intervention - optimal medical therapy - systematic review - meta-analysis

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