"A nonsurgical procedure called percutaneous coronary intervention PCI along with prescribed medication is better than medication alone as initial treatment for people who have the most common form of heart disease suggests an analysis of an international clinical trial coled by St. Michaels Hospital.  Published today in the New England Journal of Medicine and simultaneously presented at EuroPCR  in Paris France the fiveyear analysis of the FAME  trial shows that initial PCI along with medication was associated with a significant reduction in urgent hospital admissions and revascularizations to restore blood flow in the blood vessels of the heart and a likely reduction in heart attacks as compared to medication as the only treatment. The medication used in the FAME  trial consisted of a combination of aspirin cholesterollowering and blood pressurelowering drugs as required by current treatment guidelines. PCI is a minimallyinvasive procedure where modern stents  small tubular metal scaffolds coated with medication  are inserted into an artery using a small catheter to widen a narrowed blood vessel in the heart. PCI is commonly used to treat sudden blockages of a coronary artery that cause a heart attack. In situations where the hearts arteries narrow less suddenly and do not cause a heart attack but induce chest pain during exercise  a condition known as stable coronary artery disease  it has remained unclear whether PCI in addition to medication was better than medication alone in preventing future heart attacks.  Currently the standard practice in North America is to prescribe medication to patients with stable coronary artery disease and avoid PCI said Dr. Peter Jni Director of the Applied Health Research Centre AHRC at the Li Ka Shing Knowledge Institute of St. Michaels Hospital who is a senior author on the study. Our results pose the question Would a large portion of patients benefit from early PCI in addition to medication  We used pressure measurements inside the heart arteries to find coronary arteries that should be widened said Dr. Bernard De Bruyne an interventional cardiologist at the Cardiovascular Center Aalst in Belgium and the Principal Investigator of the trial. With these measurements we were able to identify patients who would benefit from PCI in addition to medication. The World Health Organization reports that every year . million people die from cardiovascular diseases which is an estimated  per cent of all deaths worldwide. Coronary artery disease is the most common type of heart disease in North America and Europe and is a serious health problem worldwide. It occurs when the coronary arteries become narrow and hardened due to the buildup of cholesterol rich plaques in the blood vessels. While the FAME  trial showed that PCI reduced urgent hospital admissions and revascularizations and likely reduced heart attacks it did not provide evidence for a difference between PCI and medication alone in the prevention of deaths. The trial was initially sponsored by St. Jude Medical a global medical device company until the threeyear followup. The subsequent two years of followup have been academically driven organized the by the academic steering committee of the study. Nineteen sites across Europe and North America participated in the fiveyear followup.  Our trial over its entire followup shows us that the longer you observe these patients the more pronounced the benefits of the initial PCI become said Dr. Jni who is also a Canada Research Chair and a Professor of Medicine at the University of Toronto.  While Drs. Jni and De Bruyne agree there is more research to be done using modern PCI technology this fiveyear followup offers evidence that PCI has the potential to provide longterm benefits to patients with stable coronary artery disease.  The FAME  trial was supported by St. Jude Medical. The present analysis was not supported by industry funding. About St. Michaels Hospital St. Michaels Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than  academic disciplines. Critical care and trauma heart disease neurosurgery diabetes cancer care care of the homeless and global health are among the Hospitals recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre which make up the Li Ka Shing Knowledge Institute research and education at St. Michaels Hospital are recognized and make an impact around the world. Founded in  the hospital is fully affiliated with the University of Toronto. Media contact Ana Gajic  Senior Communications Advisor  St. Michaels Hospital  Phone  or     Gajicasmh.ca mailtoGajicasmh.ca  Inspired Care. Inspiring Science.  http  Follow us on Twitter http"