Interventional Versus Conservative Management In Patients With Unstable Angina And Severe Coronary Lesions

Objectives:To evaluate the clinical outcomes of patients with unstable angina and severe coronary lesions, comparing those who underwent interventional treatment for the severe lesion with those who did not (conservative treatment).Methods:In this multicentre pseudo-randomized trial, a total of 159 patients with unstable angina who had at least one severe coronary lesions (diameter stenosis rate≥75% showed by the coronary angiographic) were assigned to receive an intervention (n=80) or a conservative strategy (n=79) group. In each group, the standard and proper medical treatments were available. The primary endpoints: MACCE (cardiac death, nonfatal myocardial infarction and hospital readmission rate) and the secondary endpoints (Presence of angina, revascularization and treatment costs) were evaluated in follow-ups.Result:At 2-year follow-up, rates of death or non-fatal myocardial infarction (OR 1.54 95%CI 0.25-9.35)were similar. However, at a median of 24 months'follow-up, 15(18.75%)patients with intervention treatment and 29(36.71)with conservative treatment made the hospital readmission(OR 2.51,95%CI 1.23-5.13,p=0.01),with a more benefits for the hospital readmission in the interventional group.132 [15%] conservative) patients died during follow-up (0·76,0·58-1·00, p=0054). The symptoms of angina were improved significantly in the interventional group, especially at the 3-months'follow-up (OR 3.54,95%CI 1.45-8.61,P=0.005). The difference disappear at the end of 24-months'follow-up, But the costs in the interventional group were far more the other.Conclusions:In patients with unstable angina and severe coronary lesions, a routine interventional strategy is preferable to a conservative strategy, mainly because of the reduction of the hospital readmission rates and halving of the severe angina, but no reduction of the cardiac death and nonfatal myocardial infarction and increased treatments costs.