Optimal Medical Therapy With or Without Percutaneous Coronary Intervention to Reduce Ischemic Burden

• DOI: 10.1161/circulationaha.107.743963
• Publication Date: 2008-02-12T02:10:13Z
• Authors: Leslee J. Shaw; Daniel S. Berman; David J. Maron; G. B. John Mancini; Sean W. Hayes; Pamela M. Hartigan; William S. Weintraub; Robert A. O’Rourke; Marcin Dada; John A. Spertus; Bernard R. Chaitman; John Friedman; Piotr Slomka; Gary V. Heller; Guido Germano; Gilbert Gosselin; Peter Berger; William J. Kostuk; Ronald G. Schwartz; Merill Knudtson; Emir Veledar; Eric R. Bates; Benjamin McCallister; Koon K. Teo; William E. Boden
• Keywords: Medical Therapy

Background— Extent and severity of myocardial ischemia are determinants risk for patients with coronary artery disease, reduction is an important therapeutic goal. The Clinical Outcomes Utilizing Revascularization Aggressive Drug Evaluation (COURAGE) nuclear substudy compared the effectiveness percutaneous intervention (PCI) added to optimal medical therapy (OMT) use perfusion single photon emission computed tomography (MPS). Methods Results— Of 2287 COURAGE patients, 314 were enrolled in this serial rest/stress MPS performed before treatment 6 18 months (mean=374±50 days) after randomization using paired exercise (n=84) or vasodilator stress (n=230). A blinded core laboratory analyzed quantitative measures percent ischemic myocardium. Moderate severe encumbered ≥10% primary end point was ≥5% myocardium at follow-up. Treatment groups had similar baseline characteristics. At follow-up, greater PCI+OMT (−2.7%; 95% confidence interval, −1.7%, −3.8%) than OMT (−0.5%; −1.6%, 0.6%; P <0.0001). More exhibited significant (33% versus 19%; =0.0004), especially moderate pretreatment (78% 52%; =0.007). Patients lower unadjusted death infarction ( =0.037 [risk-adjusted =0.26]), particularly if =0.001 =0.08]). Death rates ranged from 0% 39% no residual on follow-up =0.002 =0.09]). Conclusions— In who underwent MPS, adding PCI resulted alone. Our findings suggest a target without revascularization.