Optimal Medical Treatment Versus Percutaneous Coronary Intervention in Chronic Coronary Syndrome

Background The management of Chronic Coronary Syndrome (CCS) is often faced with the dilemma of the efficacy of Percutaneous Coronary Intervention (PCI) versus Optimal Medical Therapy (OMT). Despite advancements in medical treatments and stent technology, the relative benefits of these approaches remain under debate. Methods We carried out a single-blind randomized controlled trial comparing Major Adverse Cardiac Events (MACE) between OMT and PCI in 378 CCS patients in Indonesia. Patients were categorized based on their management approaches: revascularization (PCI + OMT) or no revascularization (OMT only). We excluded patients with history of CABG, stroke, heart failure, myocardial infarction, incomplete data, or those lost to follow-up, resulting in a final sample of 108 patients. The primary outcome was the incidence of MACE, including death, stroke, myocardial infarction, and hospitalization due to heart failure, during a 5-year follow-up period. Results The Hazard Ratio for death was 0.477 (95% CI: 0.262-0.869, P = .016). Similarly, the HR for myocardial infarction was 0.473 (95% CI: 0.209-1.073, P = .073), suggesting a trend towards lower risk with PCI. For stroke, the HR was 0.692 (95% CI: 0.245-1.949, P = .485), indicating no significant difference between PCI and OMT. In terms of hospitalization due to heart failure, the HR was 0.469 (95% CI: 0.196-1.121, P = .089), again showing a trend towards benefit with PCI, but not reaching statistical significance. These findings emphasize the possible benefits of PCI compared to OMT in lowering the risk of death and myocardial infarction in CCS patients. Conclusion MACE rates were higher in the OMT group compared to PCI in CCS patients. These results underscore the potential benefits of PCI Intervention over OMT in reducing adverse cardiac events.