Author/Authors :
Maron، نويسنده , , David J. and Spertus، نويسنده , , John A. and Mancini، نويسنده , , G.B. John and Hartigan، نويسنده , , Pamela M. and Sedlis، نويسنده , , Steven P. and Bates، نويسنده , , Eric R. and Kostuk، نويسنده , , William J. and Dada، نويسنده , , Marcin and Berman، نويسنده , , Daniel S. and Shaw، نويسنده , , Leslee J. and Chaitman، نويسنده , , Bernard R. and Teo، نويسنده , , Koon K. and Oʹ، نويسنده ,
Abstract :
We explored the safety and quality-of-life consequences of treating patients with stable coronary disease and high-risk features initially with optimal medical therapy (OMT) alone compared to OMT plus percutaneous coronary intervention. This was a post hoc analysis of Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial patients. We defined high risk as the onset of Canadian Cardiovascular Society class III angina within 2 months or stabilized acute coronary syndrome within 2 weeks of enrollment. The primary end point was death or myocardial infarction after 4.6 years. Of the 2,287 patients enrolled in the COURAGE trial, 264 (12%) were high risk and had a relative risk of 1.56 for death or myocardial infarction (p = 0.0008) compared to those with non–high-risk features. A total of 35 primary events occurred in the OMT group and 32 in the percutaneous coronary intervention plus OMT group (hazard ratio 1.11, 95% confidence interval 0.69 to 1.79; p = 0.68). No significant difference was found in the prevalence of angina between the 2 groups at 1 year. During the first year of follow-up, 30% of the OMT patients crossed over to the revascularization group. In conclusion, an initial strategy of OMT alone for high-risk patients in the COURAGE trial did not result in increased death or myocardial infarction at 4.6 years or worse angina at 1 year, but it was associated with a high rate of crossover to revascularization.
