# Percutaneous coronary intervention (stents)

Intervention · id `cardio:pci` · Cardiovascular Atlas · release `f6f6f1b6f50379ed` (public)

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Also called: PCI; Coronary angioplasty; Stenting

Browse, organ or system: Heart  
Browse, condition area: Coronary and vascular disease  

## In plain language

A procedure that opens a narrowed or blocked artery of the heart. A catheter carries a balloon to the narrowing, the balloon is inflated to widen the artery, and a stent, which is a tube of mesh, may be left in place to hold it open. In people with stable coronary disease, the ISCHEMIA trial did not find that starting with an invasive strategy beat medicines alone.

## Technical summary

A US government patient page says percutaneous coronary intervention, also called coronary angioplasty, opens coronary arteries narrowed or blocked by plaque, and that a stent may be placed to keep the artery from narrowing again. The only trial evidence recorded is ISCHEMIA, whose invasive strategy was angiography with revascularization when feasible, covering PCI and bypass surgery together, in stable coronary disease. It is not evidence about PCI during a heart attack.

## Claims, with the population each applies to

## Context: Adults with stable coronary disease and moderate or severe ischemia (ISCHEMIA)

Recipient: Adult; Population: Patients with stable coronary disease and moderate or severe ischemia (abstract); 5179 were randomly assigned. The registry gives a minimum age of 21 years and all sexes.; Care setting: Open-label strategy trial; the registry records masking as none. Site list not read.; Geography: Multinational: the study record lists every country the registry names; Life stage: Adult, 21 years and older (registry minimum age); Follow-up: Median follow-up 3.2 years (abstract).

### ISCHEMIA randomly assigned 5179 patients with stable coronary disease and moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible, plus medical therapy) or an initial conservative strategy of medical therapy alone. Over a median of 3.2 years, there were 318 primary outcome events in the invasive group and 352 in the conservative group. The cumulative event rate at 6 months was 5.3% against 3.4% (difference 1.9 percentage points, 95% CI 0.8 to 3.0), and at 5 years 16.4% against 18.2% (difference -1.8 percentage points, 95% CI -4.7 to 1.0). There were 145 deaths with the invasive strategy and 144 with the conservative strategy (hazard ratio 1.05, 95% CI 0.83 to 1.32). The authors report that they did not find evidence that an initial invasive strategy reduced the risk of ischemic cardiovascular events or death from any cause, and that the findings were sensitive to the definition of myocardial infarction.

- Category: Effect
- Evidence stage: Interventional
- Certainty: Certainty not assessed
- Applies to: Recipient: Adult; Population: Patients with stable coronary disease and moderate or severe ischemia (abstract); 5179 were randomly assigned. The registry gives a minimum age of 21 years and all sexes.; Care setting: Open-label strategy trial; the registry records masking as none. Site list not read.; Geography: Multinational: the study record lists every country the registry names; Life stage: Adult, 21 years and older (registry minimum age); Follow-up: Median follow-up 3.2 years (abstract).
- Limitations: This was a null result for the primary outcome. The invasive strategy was angiography with revascularization when feasible, which covers stents (PCI) and bypass surgery, so the result cannot be read as the effect of PCI alone. The trial was open-label (the registry records masking as none), and the conservative group could cross over to angiography if medical therapy failed. The population was stable coronary disease with moderate or severe ischemia, not people having a heart attack. Abstract only.
- Last checked: 2026-10-14
- Sources:
  1. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, METHODS, sentence 1, fragment 1 of 2: "We randomly assigned 5179 patients with moderate or severe ischemia to an initial invasive strategy (angiography and revascularization when feasible)". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Abstract of the paper from PubMed; the full text was not read.
  2. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, METHODS, sentence 1, fragment 2 of 2: "and medical therapy or to an initial conservative strategy of medical therapy alone and angiography if medical therapy failed.". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Conservative strategy definition.
  3. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, METHODS, sentence 2: "The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest.". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Primary outcome.
  4. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, RESULTS, sentence 1: "Over a median of 3.2 years, 318 primary outcome events occurred in the invasive-strategy group and 352 occurred in the conservative-strategy group.". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Primary outcome events and follow-up.
  5. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, RESULTS, sentence 2, fragment 1 of 3: "At 6 months, the cumulative event rate was 5.3% in the invasive-strategy group and 3.4% in the conservative-strategy group (difference, 1.9 percentage points;". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Cumulative event rate at 6 months.
  6. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, RESULTS, sentence 2, fragment 2 of 3: "95% confidence interval \[CI\], 0.8 to 3.0); at 5 years, the cumulative event rate was 16.4% and 18.2%, respectively (difference, -1.8 percentage points;". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Cumulative event rate at 5 years.
  7. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, RESULTS, sentence 2, fragment 3 of 3: "95% CI, -4.7 to 1.0).". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Five-year difference interval.
  8. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, RESULTS, sentence 5: "There were 145 deaths in the invasive-strategy group and 144 deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to 1.32).". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Deaths in each group.
  9. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, CONCLUSIONS, sentence 1, fragment 1 of 3: "Among patients with stable coronary disease and moderate or severe ischemia, we did not find evidence that an initial invasive strategy,". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Conclusion, first part.
  10. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, CONCLUSIONS, sentence 1, fragment 2 of 3: "as compared with an initial conservative strategy, reduced the risk of ischemic cardiovascular events or death from any cause over a median of 3.2". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Conclusion, second part.
  11. Supports: Initial Invasive or Conservative Strategy for Stable Coronary Disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. PMC lists a copy (PMC7263833) that is not in the PMC Open Access subset, so the full text was not fetched. The version of record was not fetched.) <https://doi.org/10.1056/NEJMoa1915922>
     Locator: Abstract, CONCLUSIONS, sentence 2: "The trial findings were sensitive to the definition of myocardial infarction that was used.". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e.
     How it applies: Sensitivity to the myocardial infarction definition.
  12. Supports: International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) (Registry, edition ClinicalTrials.gov API v2 record, last update posted 2023-06-01.) <https://clinicaltrials.gov/study/NCT01471522>
     Locator: protocolSection.designModule.enrollmentInfo.count: "5179". Retrieved 2026-10-14T18:18:37Z. Source state: Current. Snapshot hash: aa11fdbe65af845de0cf9cfcbf7b298c3f47057c0d71c36333dbfc9d2bdc8df9.
     How it applies: Registry enrollment count, equal to the abstract.

## Connected pages

- Initial invasive strategy compared with medicines alone: Coronary artery disease (`cardio:coronary-artery-disease`) [a claim, not a settled fact; see claim `cardio:claim-ischemia-initial-invasive-strategy` and its context]
- Files under this front: Procedures and surgery (`cardio:front-procedures-and-surgery`)
- Has subtype: Emergency stenting for ST-elevation heart attack (primary PCI) (`cardio:primary-pci-for-stemi`)
- Investigated in: ISCHEMIA (initial invasive or conservative strategy for stable coronary disease) (`cardio:ischemia-trial`)

## Provenance

Content hash: 46d65c94740c3cc5ab94cbde6123d57d4082537fa0db5bfab35f7e423cce1a8e
Last substantive edit: 2026-10-15
Evidence last checked: 2026-10-14