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Editorial
Percutaneous revascularisation in chronic coronary syndromes: when real-world data unveil the other side of the coin
  1. Federico Giacobbe1,2,
  2. Fabrizio D'Ascenzo1,2
  1. 1Department of Medical Sciences, University of Turin, Turin, Italy
  2. 2Division of Cardiology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
  1. Correspondence to Dr Fabrizio D'Ascenzo; fabrizio.dascenzo{at}gmail.com

https://doi.org/10.1136/heartjnl-2024-324909

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    The optimal treatment of chronic coronary syndromes (CCS) represents to date a matter of debate as revascularisation has not shown a real advantage over optimal medical therapy (OMT) alone on long-term overall survival, and has recently been reaffirmed in the latest guidelines as a useful strategy only in case of an ineffective response to OMT.1 Indeed, if the recently published ORBITA-2 trial demonstrated the benefit of revascularisation in relieving angina symptoms,2 many other trials aiming to show a benefit on hard outcomes have failed in their purpose. In many trials, revascularisation in addition to OMT was not effective in either improving survival or reducing adverse events compared with OMT alone, except for a subcohort of patients treated with coronary artery bypass grafting (CABG) in BARI-2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial.3 The ISCHEMIA-EXTEND reported the extended follow-up of the recent ISCHEMIA trial showing in the group invasively treated at an average 7-year follow-up a significant reduction of cardiovascular mortality, which was however outweighed by the increase in non-cardiovascular mortality, resulting in no overall …

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    Footnotes

    • Contributors FG was involved in conceptualisation and writing. FD'A was responsible for conceptualisation, revision and supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.

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