Conservative strategy for treatment of stable coronary artery disease

Table 1 Main randomized clinical trials comparing medical therapy alone with coronary interventions in stable coronary artery disease patients

Clinical scenario	Clinical trial	Randomization period	n	Study groups	Annual mortality	Main findings
Single-vessel CAD	MASS I (3.5 yr)	1988-1991	214	MT 72 PCI 72 CABG 70	MT 0 PCI 0.4% CABG 0.4%	Similar mortality and MI among the 3 groups
Multivessel CAD (majority of trials’ patients)	VA (18 yr)	1972-1974	686	MT 354 CABG 332	MT 3.7% CABG 3.9%	Similar mortality and MI rates in the 2 groups
	ECSS (12 yr)	1973-1976	767	MT 373 CABG 394	MT 2.7% CABG 2.4%	Mortality higher in MT group in 3-vessel disease patients
	CASS (10 yr)	1975-1979	780	MT 390 CABG 390	MT 2.1% CABG 1.9%	Similar mortality in 1, 2 or 3-vessel with EF ≥ 0.50. CABG was superior in 3-vessel with EF < 0.50
	MASS II (5 yr)	1995-2000	611	MT 203 PCI 205 CABG 203	MT 2.4% PCI 2.3% CABG 1.6%	Similar mortality in the 3 groups. Similar events in MT and PCI. CABG superior in terms of reinterventions
	COURAGE (4.6 yr)	1999-2004	2287	MT 1138 PCI 1149	MT 1.8% PCI 1.65%	Similar mortality and events in the 2 groups
Impaired ventricular function	STICH (4.6 yr)	2002-2007	1212	MT 602 CABG 610	MT 8.8% CABG 7.7%	Similar mortality rates. CABG superior in terms of hospitalization for cardiac causes
Diabetes mellitus	BARI 2D (5.3 yr)	2001-2005	2368	MT 1192 CABG/ PCI 1176	MT 2.3% CABG/PCI 2.2%	Similar mortality and MI rates in the 2 strategies
Elderly	TIME (3.1 yr)	1996-2000	282	MT 142 CABG/PCI 140	MT 7.2% CABG/PCI 6.8%	Similar mortality and MI rates between the 2 strategies

CAD: Coronary artery disease; MASS: Medical, Angioplasty or Surgery Study; VA: Veterans Affairs; ECSS: European Coronary Surgery Study; STICH: Surgical Treatment for Ischemic Heart Failure; TIME: Medical Therapy in Elderly patients; MT: Medical therapy; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass surgery.