ASEAN Heart Journal

Intended for healthcare professional

Original Article

ASEAN Heart Journal

December 2014, 22:1

First online: 16 December 2014

Original Article

Pro Percutaneous Coronary Intervention (PCI) in Patients with Stable Angina (SA)

Vincent Michiels,1 Eric Eeckhout MD, PhD1
Open Access
This content is freely available to anyone, anywhere at any time.
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  • Supplementary Material
  • About this Article
  • References


In this article, we will defend percutaneous coronary intervention (PCI) ‚ÄĒ and revascularization as a whole ‚ÄĒ as a first line treatment in patients with stable angina pectoris. In our opinion, there is strong and sufficient evidence to advocate PCI as an adjunct to medical therapy in the optimal treatment of stable angina (SA). Our argument is based on four pillars: (1) SA patients concern a heterogeneous population; (2) not every SA patient is created equal; (3) obvious limitations of medical therapy; and(4)the issue of symptom control.


Percutaneous Coronary Intervention - Stable Angina - Fractional Flow Reserve - Optimal Medical Therapy - High Clinical Risk

Corresponding author: Eric Eeckhout, MD, PhD, Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Email:, Tel +41 21 3141111.
Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Supplementary Material



About this Article


Pro Percutaneous Coronary Intervention (PCI) in Patients with Stable Angina (SA)

Open Access

Available under Open Access


>> ASEAN Heart Journal 

>> 22:1

Online Date

21 November 2019



Online ISSN



ASEAN Federation of Cardiology

Additional Links

>> About The AHJ




Percutaneous Coronary Intervention

Stable Angina

Fractional Flow Reserve

Optimal Medical Therapy

High Clinical Risk

Author Affiliations

1. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Correspondence to:

Eric Eeckhout,


1. Gitt A, Hochadel M, Zeymer U, et al. (2011) Current practice of PCI for ACS and stable angina in Europe 2005-2008: Lessons from the Euro heart survey PCI registry free. JACC 57: E1774.

2.¬†Boden W,¬†O‚ÄôRourke R, Teo K,¬†et al. for the COURAGE trial research group. (2007) Optimal medical therapy with or without PCI for stable coronary disease.¬†New Engl J Med¬†356: 1503‚Äď1516.


4. Zipes DP, Libby P, Bonow RO, Braunwald. (2007) Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed. Elsevier Saunders.

5.¬†Fox K,¬†Garcia M, Ardissino D,¬†et al. (2006) Guidelines on the management of stable angina pectoris: Executive summary - The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology.¬†Eur Heart J¬†27: 1341‚Äď1381.

6.¬†Calvert P,¬†Steg PG. (2012) Towards evidence-based percutaneous coronary intervention: The Ren√© La√ęnnec lecture in clinical cardiology.¬†Eur Heart J¬†33: 1878‚Äď1885. PubMed¬† ¬†CrossRef

7.¬†Stergiopoulos K,¬†Brown DL. (2012) Initial coronary stent implantation with medical therapy vs. medical therapy alone for stable coronary artery disease: Meta-analysis of randomized controlled trials.¬†Arch Intern Med¬†172: 312‚Äď319. PubMed

8.¬†Pursani S, Korley F, Gopaul R,¬†et al. (2012) Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: A systematic review and meta-analysis of randomized clinical trials.¬†Circ Cardiovasc Interv¬†5: 476‚Äď490.

9.¬†Schomig A,¬†Mehili J, de Waha A,¬†et al. (2008) A metaanalysis of 17 randomized trials of a percutaneous coronary intervention-based strategy in patients with stable coronary artery disease.¬†JACC¬†52: 894‚Äď904.

10.¬†Wijns W,¬†Kolh P, Danchin, N¬†et al. (2010) Guidelines on myocardial revascularization. The task force on myocardial revascularization of the ESC and the EACTS.¬†Eur Heart J¬†31: 2501‚Äď2555.

11.¬†Conley M,¬†Ely R, Kisslo, J¬†et al. (1978) The prognostic spectrum of left main stenosis.¬†Circulation¬†57: 947‚Äď952.

12.¬†Caracciolo E,¬†Davis K, Sopko G,¬†et al. (1995) Comparison of surgical and medical group survival in patients with left main equivalent coronary artery disease: Long-term CASS experience.¬†Circulation¬†91: 2335‚Äď2344.

13.¬†Park SJ,¬†Kim YH, Park DW,¬†et al. (2011) Randomized trial of stents versus bypass surgery for left main coronary artery disease.¬†New Engi J Med¬†364: 1718‚Äď1727.

14.¬†Morice MC,¬†Serruys P, Kappetein, A¬†et al. (2010) Outcomes in patients with de novo left main disease treated with ither percutaneous coronary intervention using paclitaxel-eluting stents or coronary artery bypass graft treatment in the synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) trial.¬†Circulation¬†121: 2645‚Äď2653.

15.¬†Park DW,¬†Seung KB, Kim YH,¬†et al. (2012) Long-term safety and efficacy of stenting versus coronary artery bypass grafting for unprotected left main coronary artery disease. 5-year results from the MAIN-COMPARE registry.¬†JACC¬†56: 117‚Äď124.

16.¬†Califf R,¬†Armstrong P, Carver J,¬†et al. (1996) Task force 5. Stratifi cation of patients into high, medium and low risk subgroups for purposes of risk factor management.¬†JACC¬†27: 964‚Äď1047.

17. Smith P, Califf R, Tuttle R, et al. (2006) Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann Thorac Surg 82: 14201429.

18.¬†Tsuyuki R,¬†Shrive F, Galbraith P,¬†et al. for the APPROACH investigators. (2006) Revascularization in patients with heart failure.¬†CMAJ¬†175: 361‚Äď365.

19. Allman K, Shaw L, Hachamovitch R, Udelson J. (2002) Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a metaanalysis. JACC 39: 1151-1158.

20.¬†Hachamovitch R,¬†Hayes S, Friedman J,¬†et al. (2003) Comparison of the short-term survival benefit associated with revascularization compared to medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography.¬†Circulation¬†107: 2900‚Äď2906. PubMed¬† ¬†CrossRef

21.¬†Shaw L,¬†Berman D, Maron D,¬†et al. (2008) Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the COURAGE trial nuclear substudy.¬†Circulation¬†117: 1283‚Äď1291.


23.¬†De Bruyne B,¬†Pijls N, Kalesan B,¬†et al. for the FAME 2 trial investigators. (2012) Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease.¬†New Engl J Med¬†367: 991‚Äď1001.

24.¬†Hannan E,¬†Samadashvili Z, Cozzens K,¬†et al. (2012) Comparative outcomes for patients who do and do not undergo percutaneous coronary intervention for stable coronary artery disease in New York.¬†Circulation¬†125:1870‚Äď1879.

25.¬†Maron D,¬†Boden W, O‚ÄôRourke R, et al. (2010) Intensive multifactorial intervention for stable coronary artery disease: optimal medical therapy in the COURAGE trial.¬†JACC¬†55: 1348‚Äď1358. PubMed

26.¬†Baroletti S,¬†Dell‚ÄôOrfano H. (2010) Medication adherence in cardiovascular disease.¬†Circulation¬†121: 1455‚Äď1458. PubMed¬†¬†CrossRef

27.¬†Wijeysundera H,¬†Nallamothu B, Krumholz H,¬†et al. (2010) Meta-analysis: effects of percutaneous coronary intervention versus medical therapy on angina relief.¬†Ann Intern Med¬†152: 370‚Äď379.

28.¬†Weintraub W,¬†Spertus J, Kolm P,¬†et al. for the COURAGE trial research group. (2008) Effect of PCI on quality of life in patients with stable coronary disease.¬†New Engl J Med¬†359: 677‚Äď687.

29.¬†Dagenais G,¬†Lu J, Faxon D,¬†et al. and the BARI 2D study group. (2011) Effects of optimal medical treatment with or without coronary revascularization on angina and subsequent revascularization in patients with type 2 diabetes mellitus and stable ischemic heart disease.¬†Circulation¬†123: 1492‚Äď1500.

30.¬†De Quadros A,¬†Lima T, Rodrigues A,¬†et al. (2011) Quality of life and health status after percutaneous coronary intervention in stable angina patients: results from the realworld practice.¬†Cath Cardiovasc Interv¬†77: 954‚Äď960.

31. Eeckhout E, Serruys P, Wijns W, et al. (2012) Percutaneous interventional cardiovascular medicine. The PCR-EAPCI textbook, 2012. Online version. Chapter 3.16: Interventions for stable coronary disease.

32.¬†Blankenship JC.¬†(2011) Editorial comment: Take that stent nihilists: additional evidence for the benefits of coronary¬†Cath Cardiovasc Interv¬†78:177‚Äď178. CrossRef