Banris What I find surprising is the surprised reaction of many commentators. N Engl J Med Mar 27; [pub ahead of print]. Commentary by Cara Litvin, PGY-3 The results of one of the more remarkable studies from the meeting of the American College of Cardiology were presented on Monday, along with the simultaneous early publishing of the study online in the New England Journal of Medicine. Half of tgial patients undergoing urgent revascularization had no objective evidence of ischemia i.
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Mean Follow-Up: Median, 4. Anti-ischemic therapy included long-acting metoprolol, amlodipine, and isosorbide mononitrate, alone or in combination, and either lisinopril or losartan as secondary prevention.
One-third of patients had proximal disease of the left anterior descending artery. Diet, exercise, and smoking cessation were also high in both groups. The primary endpoint of death or MI did not differ for the PCI group compared with the medical therapy group Findings were similar during extended follow-up to 15 years. There was also no difference between PCI and medical therapy in the secondary composite endpoint of death, MI, or stroke Components of the composite endpoints did not differ between groups, including death 7.
The strongest predictor of improved 1-year survival was being a nonsmoker, regular physical activity, systolic blood pressure Interpretation: Among patients with stable coronary artery disease, treatment with PCI was not associated with a difference in death or MI compared with treatment with medical therapy through 15 years of follow-up. Freedom from angina occurred slightly more frequently with PCI early in the trial but did not differ between the PCI and medical therapy groups by 5 years, with both arms showing marked reductions in angina throughout the trial.
Findings from the present study apply to stable angina patients and cannot be extrapolated to the acute coronary syndrome population, which has different pathophysiologic characteristics. The majority of the PCI group did not receive drug-eluting stents since most of the enrollment was completed prior to the introduction of these stents. The greater the number of risk factors in control during follow-up, the greater probability of 1-year survival.
J Am Coll Cardiol ; Editorial Comment: Bittner V. Effect of PCI on long-term survival in patients with stable ischemic heart disease. N Engl J Med ; Effect of PCI on quality of life in patients with stable coronary disease. Presented by Dr. William E.
COURAGE TRIAL NEJM PDF
Print Image: PD 1. Addition of percutaneous cutaneous intervention PCI to optimal medical therapy for patients with stable coronary artery disease does not improve mortality or cardiovascular outcomes Study Rundown: The COURAGE trial was the first to provide evidence that in patients with stable coronary artery disease, the addition of PCI to optimal medical therapy does not provide any mortality benefit or improve cardiovascular outcomes. A subsequent report from the COURAGE investigators demonstrated that patients who received PCI were free of angina and had improvements in various quality of life parameters at three months after the intervention, though this difference was not sustained at 36 months. Optimization of medical therapy alone without PCI is sufficient for initial treatment of patients with stable coronary artery disease. The addition of PCI to optimal medical therapy does not improve mortality or cardiovascular outcomes as evidenced by the COURAGE trial, and given its risks as an invasive procedure, should not be offered as initial treatment strategy for this patient population. Patients were randomized to two groups: 1 optimal medical therapy alone, or 2 optimal medical therapy with PCI.
Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation - COURAGE