De behandeling van stabiel kransvatlijden

No trial or meta-analysis in patients with stable coronary artery disease, normal left ventricular function and without left main stenosis, has shown that adding revascularization to optimal medical therapy (OMT) decreases hard endpoints: myocardial infarction (MI) and overall mortality. However, Navarese concludes that OMT with elective revascularization reduces "cardiac" mortality, and is associated with a reduction in spontaneous MI. His meta-analysis is biased by a less hard primary endpoint “cardiac mortality” (often poorly defined and/or not independently assessed), exclusion of revascularisation-related MI and inclusion of vintage trials without platelet aggregation inhibitors, statins or PCIs. Overall the description of OMT is incomplete; even after 2000 the LDL cholesterol values are missing in half of the trials. Trials and meta-analyses without a clear focus on OMT and without clear and hard primary endpoints do not provide clear information for the doctor in the consulting room who wants to make the best treatment choice.

Conflict of interest and financial support: none declared.