Ischaemic heart disease

Stent or surgery? ▸ The stent or surgery (SoS) trial has finally been published. Its findings are well known, and suggest that stenting in multivessel disease does not result in more deaths/myocardial infarction (MI) than coronary artery bypass surgery (CABG). However, by one year, 17% of those treated with stents have needed another procedure compared to only 4% in the CABG arm. There was an increase in deaths in the coronary angioplasty (PTCA) arm, but this was related to an excess of cancer deaths which was almost certainly a play of chance. The trial does not offer information on diabetic patients, however, as there were few in either arm.

▴ SOS Investigators. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the stent or surgery trial): a randomised controlled trial. Lancet2002;360:965–70.OpenUrlCrossRefPubMedWeb of Science

RITA-3: a call for more coronary intervention ▸ In a randomised trial of 1810 patients with non-ST elevation acute coronary syndromes, patients were assigned an early intervention (97% angiography, 57% revascularised at one year) or conservative strategy (50% had angiography, 28% revascularised at one year). At four months, 86 (9.6%) of 895 patients in the intervention group had died or had a myocardial infarction or refractory angina, compared with 133 (14.5%) of 915 patients in the conservative group (risk ratio 0.66, 95% confidence interval (CI) 0.51 to 0.85, p = 0.001). This difference was due mainly to a halving of refractory angina in the intervention group. Death or myocardial infarction was similar in both treatment groups at one year (68 (7.6%) v 76 (8.3%), respectively; risk ratio 0.91, 95% CI 0.67 to 1.25, p = 0.58). Overall the RITA-3 population was at lower risk than in other similar trials (8% one year death/MI …