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Circulation: Cardiovascular Quality and Outcomes
Year: 2009  |  Volume: 2  |  Issue: 4  |  Page No.: 320 - 327

Quantitative Results of Baseline Angiography and Percutaneous Coronary Intervention in the COURAGE Trial

G.B. J Mancini, E. R Bates, D. J Maron, P Hartigan, M Dada, G Gosselin, W Kostuk, S. P Sedlis, L. J Shaw, D. S Berman, P. B Berger, J Spertus, K Mavromatis, M Knudtson, B. R Chaitman, R. A O'Rourke, W. S Weintraub, K Teo, W. E Boden and on behalf of the COURAGE Trial Investigators and Coordinators    

Abstract:

Background— COURAGE compared outcomes in stable coronary patients randomized to optimal medical therapy plus percutaneous coronary intervention (PCI) versus optimal medical therapy alone.

Methods and Results— Angiographic data were analyzed by treatment arm, health care system (Veterans Administration, US non–Veterans Administration, Canada), and gender. Veterans Administration patients had higher prevalence of coronary artery bypass graft surgery and left ventricular ejection fraction ≤50%. Men had worse diameter stenosis of the most severe lesion, higher prevalence of prior coronary artery bypass graft surgery, lower left ventricular ejection fraction, and more 3-vessel disease that included a proximal left anterior descending lesion (P<0.0001 for all comparisons versus women). Failure to cross rate (3%) and visual angiographic success of stent procedures (97%) were similar to contemporary practice in the National Cardiovascular Data Registry. Quantitative angiographic PCI success was 93% (residual lesion <50% in-segment) and 82% (<20% in-stent), with only minor nonsignificant differences among health care systems and genders. Event rates were higher in patients with higher jeopardy scores and more severe vessel disease, but rates were similar irrespective of treatment strategy. Within the PCI plus optimal medical therapy arm, complete revascularization was associated with a trend toward lower rate of death or nonfatal myocardial infarction. Complete revascularization was similar between genders and among health care systems.

Conclusions— PCI success and completeness of revascularization did not differ significantly by health care system or gender and were similar to contemporary practice. Angiographic burden of disease affected overall event rates but not response to an initial strategy of PCI plus optimal medical therapy or optimal medical therapy alone.

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