{ "release_id": "f6f6f1b6f50379ed", "id": "cardio:pci", "owner": "cardio", "kind": "intervention", "slug": "pci", "name": "Percutaneous coronary intervention (stents)", "aliases": [ "PCI", "Coronary angioplasty", "Stenting" ], "atlases": [ "cardio" ], "summary_plain": "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.", "summary_technical": "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.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-14", "next_review_due": null, "identifiers": [ { "scheme": "mesh", "value": "D062645", "normalized_value": "D062645", "match": "exact", "version": "MeSH linked-data descriptor record fetched on 2026-10-14, lastUpdated 2013-01-01; the record states no yearly MeSH release", "label": null, "from_source": false } ], "navigation": { "cardio": { "system": [ "heart" ], "condition-area": [ "coronary-and-vascular-disease" ] } }, "payload": { "subtype": "procedure", "mechanism": "A stent (a tube of mesh) holds a narrowed coronary artery open (a US government patient page)", "components": null }, "content_digest": "46d65c94740c3cc5ab94cbde6123d57d4082537fa0db5bfab35f7e423cce1a8e", "review": { "content_digest": "46d65c94740c3cc5ab94cbde6123d57d4082537fa0db5bfab35f7e423cce1a8e", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "f6f6f1b6f50379ed", "id": "cardio:claim-ischemia-initial-invasive-strategy", "owner": "cardio", "subject_entity_id": "cardio:pci", "category": "effect", "statement": "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.", "context": { "id": "cardio:ctx-ischemia-stable-coronary-disease-moderate-severe-ischemia", "label": "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_note": "Adult, 21 years and older (registry minimum age)", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Median follow-up 3.2 years (abstract).", "eligibility": { "inclusion": [ "Stable coronary disease", "Moderate or severe ischemia" ], "exclusion": [] } }, "evidence_stage": "interventional", "certainty": "not_assessed", "certainty_method": null, "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.", "editorial_state": "draft", "checked_at": "2026-10-14", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "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)\"", "applicability_note": "Abstract of the paper from PubMed; the full text was not read.", "snapshot": { "id": "cardio:pubmed-32227755-2026-10-14", "retrieved_at": "2026-10-14T18:18:37Z", "content_hash": "d345716db17b186578964e61480700f7459472617841049f0dc4a85125aa3f0e", "source_effective_date": null, "public_archive_url": null, "source_state": "current" }, "source": { "id": "cardio:pubmed-10-1056-nejmoa1915922", "source_type": "publication", "title": "Initial Invasive or Conservative Strategy for Stable Coronary Disease", "canonical_url": "https://doi.org/10.1056/NEJMoa1915922", "identifiers": [ { "scheme": "doi", "value": "10.1056/NEJMoa1915922", "normalized_value": "10.1056/nejmoa1915922", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "32227755", "normalized_value": "32227755", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC7263833", "normalized_value": "PMC7263833", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2020-04-09", "publisher": "The New England journal of medicine", "edition": "PubMed record (abstract and bibliographic data) from NCBI E-utilities. 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