Journal
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume 54, Issue 14, Pages 1303-1308Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jacc.2009.07.013
Keywords
percutaneous coronary intervention; optimal medical therapy; coronary artery disease
Categories
Funding
- Bristol- Myers Squibb/Sanofi
- Johnson Johnson
- United Healthcare
- McMaster University Medical Center, Hamilton, Ontario, Canada
- New York Harbor Health Care System and New York University School of Medicine, New York
- Western New York Health Care System
- Buffalo General Hospital
- University at Buffalo, Buffalo, New York
- VA South Texas Health Care System, San Antonio, Texas
- Vanderbilt University Medical Center, Nashville, Tennessee
- VA Cooperative Studies Program Coordinating Center
- Cooperative Studies Program of the U. S. Department of Veterans Affairs Office of Research and Development
- Canadian Institutes of Health Research
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Objectives Our aim was to access clinical effectiveness of percutaneous coronary intervention (PCI) when added to optimal medical therapy (OMT) in older patients with stable coronary artery disease (CAD). Background While older patients with CAD are at increased risk for cardiac events compared with younger patients, it is unclear whether PCI may mitigate this risk more effectively than OMT alone or, alternatively, may be associated with more complications. Methods We conducted a pre-specified analysis of outcomes in stable CAD patients stratified by age and randomized to PCI + OMT or OMT alone in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation) trial. Results A total of 1,381 patients (60%) were <65 years of age (mean 56 +/- 6 years) and 904 patients (40%) were >= 65 years of age (mean 72 +/- 5 years). Achieved treatment targets for blood pressure, low-density lipoprotein cholesterol, adherence to diet and exercise, and angina-free status did not differ by age or treatment assignment. Among older patients, there was a 2-to 3-fold higher death rate, but similar rates of myocardial infarction, stroke, and major cardiac events compared with younger patients. The addition of PCI to OMT did not improve or worsen clinical outcomes in patients <65 years of age during a median 4.6 year follow-up. Conclusions These data support adherence to American College of Cardiology/ American Heart Association clinical practice guidelines that advocate OMT as an appropriate initial management strategy, regardless of age. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]; NCT00007657) (J Am Coll Cardiol 2009; 54: 1303-8) (C) 2009 by the American College of Cardiology Foundation
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