Can Percutaneous Coronary Interventions Reduce Death and Myocardial Infarction in Stable and Unstable Coronary Disease?

In the high-risk patients such as those with an MI or cardiogenic shock, PCI clearly reduces mortality. Since PCI provides greater coronary artery patency than thrombolytic therapy with a lower risk of stroke, it is not surprising that PCI is of greater benefit to these patients when it is available. Furthermore, in patients after an MI with ischemia or angina, revascularization by a percutaneous or surgical approach is associated with a reduction in subsequent MIs. In patients with multivessel disease, including those with high-risk anatomy such as three-vessel disease and reduced ventricular function, survival appears to be as good with PCI as with CABG in patients suitable for both procedures. In patients with stable coronary disease, low-risk patients will do well without PCI on medical therapy alone. In high-risk patients with stable coronary disease such as those with poor exercise tolerance and more severe angina, PCI can clearly improve exercise duration and anginal symptoms. Moreover, in patients with multivessel disease, particularly nondiabetic patients with multivessel disease, survival is similar with PCI and CABG.