“When you put in a stent, everyone is happy — the hospital is making more money, the doctor is making more money — everybody is happier except the health care system as a whole, which is paying more money for no better results.”

Dr. Allan Schwartz, chief of cardiology at Columbia, who was not involved in the study, said that the analysis reinforced what was already known — that treatment with medicine first is usually the best approach.

“I agree with the conclusions,” he said, “but they shouldn’t be oversimplified. Cardiac disease is complicated, and there are lot of factors that go into assessing who should and shouldn’t be treated with stenting.” Sometimes a stent is indicated even in patients with stable coronary artery disease, he said — for example, when the medicine doesn’t work or has intolerable side effects.

Two recent meta-analyses showed an advantage for P.C.I. But those reviews considered patients enrolled in the 1980s and 1990s when balloon angioplasty without stents was the predominant form of surgical intervention, and when medical therapy generally did not include statins, ACE inhibitors and other drugs that are now standard in medical treatment.

This review, published in The Archives of Internal Medicine, included only prospective randomized trials that compared P.C.I. and medical therapy with medical therapy alone. There were 7,229 patients in all, half randomized to P.C.I. and half to medicine alone. More than 70 percent of the surgical patients received stents, and the studies followed patients for an average of more than four years.

Death rates were 8.9 percent with P.C.I. and 9.1 percent with medical treatment. Rates for nonfatal heart attacks were 8.9 percent for those who got stents and 8.1 percent for those on medicine alone.

P.C.I. was eventually performed on 30.7 percent of patients who got only medicine, but a second P.C.I. was required for 21.4 percent of those who got stents. None of these differences was statistically significant.