The main results of the Clinical Outcomes Utilizing Revascularization and Aggressive
DruG Evaluation (COURAGE) trial revealed no significant differences in the primary
end point of all-cause mortality or nonfatal myocardial infarction [MI] or major secondary
end points (composites of death/MI/stroke; hospitalization for acute coronary syndromes
[ACSs]) during a median 4.6-year follow-up in 2,287 patients with stable coronary
artery disease randomized to optimal medical therapy (OMT) with or without percutaneous
coronary intervention (PCI). We sought to assess the impact of PCI when added to OMT
on major prespecified tertiary cardiovascular outcomes (time to first event), namely
cardiac death and composites of cardiac death/MI, cardiac death/MI/hospitalization
for ACS, cardiac death/MI/stroke, MI/stroke, or cardiac death/MI/ACS/stroke, during
study follow-up. There were no significant differences between treatment arms for
the composite of cardiac death or MI (15% in PCI + OMT group vs 14.2% in OMT group,
hazard ratio 1.07, 95% confidence interval 0.86 to 1.33, p = 0.62) or in any of the
major prespecified composite cardiovascular events during long-term follow-up, even
after excluding periprocedural MI as an outcome of interest. Overall, cause-specific
cardiovascular outcomes paralleled closely the primary and secondary composite outcomes
of the trial as a whole. In conclusion, compared with an initial management strategy
of OMT alone, addition of PCI did not decrease the incidence of major cardiovascular
outcomes including cardiac death or the composite of cardiac death/MI/ACS/stroke in
patients with stable coronary artery disease.
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References
- Design and rationale of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial Veterans Affairs Cooperative Studies Program Number 424.Am Heart J. 2006; 151: 1173-1179
- The evolving pattern of symptomatic coronary artery disease in the United States and Canada: baseline characteristics of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial.Am J Cardiol. 2007; 99: 208-212
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Article Info
Publication History
Published online: April 20, 2009
Accepted:
February 20,
2009
Received in revised form:
February 20,
2009
Received:
December 22,
2008
Footnotes
This study was sponsored by the Department of Veterans Affairs Cooperative Studies Program. Additional funding was provided by the Canadian Institutes of Health Research. Supplemental corporate support from several pharmaceutical companies included funding and in-kind support. All support from the pharmaceutical industry consisted of unrestricted research grants payable to the Department of Veterans Affairs.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
