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Generalizing Intensive Blood Pressure Treatment to Adults With Diabetes Mellitus Variation in Revascularization Practice and Outcomes in Asymptomatic Stable Ischemic Heart Disease 10-Year Coronary Heart Disease Risk Prediction Using Coronary Artery Calcium and Traditional Risk Factors: Derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) With Validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study) 2-Year Outcomes After Stenting of Lipid-Rich and Nonrich Coronary Plaques Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review Association of CYP2C19 Loss-of-Function Alleles with Major Adverse Cardiovascular Events of Clopidogrel in Stable Coronary Artery Disease Patients Undergoing Percutaneous Coronary Intervention: Meta-analysis The year in cardiovascular medicine 2020: interventional cardiology Guiding Principles for Chronic Total Occlusion Percutaneous Coronary Intervention The spectrum of chronic coronary syndromes: genetics, imaging, and management after PCI and CABG Long-Term Effect of Ultrathin-Strut Versus Thin-Strut Drug-Eluting Stents in Patients With Small Vessel Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Subgroup Analysis of the BIOSCIENCE Randomized Trial

Review ArticleVolume 76, Issue 4, July 2020

JOURNAL:J Am Coll Cardiol. Article Link

Improving the Design of Future PCI Trials for Stable Coronary Artery Disease: JACC State-of-the-Art Review

G Marquis-Gravel, DJ Moliterno, SG Goodman et al. Keywords: PCI; trail design; SCAD

ABSTRACT

The role of percutaneous coronary interventions in addition to medical therapy for patients with stable coronary artery disease continues to be debated in routine clinical practice, despite more than 2 decades of randomized controlled trials. The residual uncertainty arises from particular challenges facing revascularization trials. Which endpoint do doctors care about, and which do patients care about? Which participants should be enrolled? What background medical therapy should we use? When is placebo control relevant? In this paper, we discuss how these questions can be approached and examine the merits and disadvantages of possible options. Engaging multiple stakeholders, including patients, researchers, regulators, and funders, to ensure the design elements are methodologically valid and clinically meaningful should be an aspirational goal in the development of future trials.