Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease

Abstract

BACKGROUND Percutaneous coronary intervention (PCI) relieves angina in patients with stable ischemic heart disease, but clinical trials have not shown that it improves survival. Between June 1999 and January 2004, we randomly assigned 2287 patients with stable ischemic heart disease to an initial management strategy of optimal medical therapy alone (medical-therapy group) or optimal medical therapy plus PCI (PCI group) and did not find a significant difference in the rate of survival during a median follow-up of 4.6 years. We now report the rate of survival among the patients who were followed for up to 15 years. METHODS We obtained permission from the patients at the Department of Veterans Affairs (VA) sites and some non-VA sites in the United States to use their Social Security numbers to track their survival after the original trial period ended. We searched the VA national Corporate Data Warehouse and the National Death Index for survival information and the dates of death from any cause. We calculated survival according to the Kaplan–Meier method and used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics. RESULTS Extended survival information was available for 1211 patients (53% of the original population). The median duration of follow-up for all patients was 6.2 years (range, 0 to 15); the median duration of follow-up for patients at the sites that permitted survival tracking was 11.9 years (range, 0 to 15). A total of 561 deaths (180 during the follow-up period in the original trial and 381 during the extended follow-up period) occurred: 284 deaths (25%) in the PCI group and 277 (24%) in the medical-therapy group (adjusted hazard ratio, 1.03; 95% confidence interval, 0.83 to 1.21; P = 0.76). CONCLUSIONS During an extended-follow-up of up to 15 years, we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease. (Funded by the VA Cooperative Studies Program and others; COURAGE ClinicalTrials.gov number, NCT00007657.)

Higher coronary artery calcification score is associated with adverse prognosis in patients with stable angina pectoris

“…The COURAGE clinical trial also did not identify a difference in survival between patients with SAP initially treated with PCI plus medical therapy or medical therapy alone during an extended follow-up (20). Even among high-risk subgroups of patients, no subgroup that derived a survival benefit could be identified.…”

Therapy of Stable Angina of Effort by Triple Combinations of Antianginal Drugs in Geriatric Practice

“…В гериатрической практике реваскуляриза-ция часто оказывается невозможной из-за технических проблем ЧКВ, тяжелых сопутствующих заболеваний и отказа от коронарного шунтирования. Кроме того, ЧКВ в дополнение к оптимальной медикаментозной терапии стабильной ИБС не улучшает отдаленные исходы по срав-нению с одной оптимальной медикаментозной терапией [11].…”

Nuclear Medicine is the Best Approach for Detecting Coronary Artery Disease

“…Survival benefit with the measurement of stress induced ischemia on MPI was reported in 2003 by Hachamovitch et al This concept was followed by Shaw in the nuclear sub-analysis of COURAGE, and proved that ≥5% of ischemic reduction led the improvement of outcomes (8). Recently the 12-year follow-up of COURAGE trial was documented (9). Additional prognostic information was available from 53% of the original population.…”