Format

Send to

Choose Destination
JACC Cardiovasc Interv. 2014 Feb;7(2):195-201. doi: 10.1016/j.jcin.2013.10.017. Epub 2014 Jan 15.

Predicting outcome in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation): coronary anatomy versus ischemia.

Author information

1
University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca.
2
Veterans Affairs Cooperative Studies Program Coordinating Center, Connecticut VA Healthcare System, West Haven, Connecticut.
3
Emory University School of Medicine, Atlanta, Georgia.
4
Cedars-Sinai Heart Institute, University of California, Los Angeles, California.
5
University of Michigan Medical Center, Ann Arbor, Michigan.
6
Vanderbilt University Medical Center, Nashville, Tennessee.
7
McMaster University Medical Center, Hamilton, Ontario, Canada.
8
VA New York Harbor Healthcare System, New York Campus, New York University School of Medicine, New York, New York.
9
St. Louis University Hospital, St. Louis, Missouri.
10
Christiana Care Health System, Newark, Delaware.
11
Mid America Heart Institute, University of Missouri, Kansas City, Missouri.
12
London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
13
Hartford Hospital, Hartford, Connecticut.
14
University of Kentucky, Lexington, Kentucky.
15
New York Health Care System, Buffalo General Hospital and the State University of New York at Buffalo, Buffalo, New York.

Abstract

OBJECTIVES:

The aim of this study was to determine the relative utility of anatomic and ischemic burden of coronary artery disease for predicting outcomes.

BACKGROUND:

Both anatomic burden and ischemic burden of coronary artery disease determine patient prognosis and influence myocardial revascularization decisions. When both measures are available, their relative utility for prognostication and management choice is controversial.

METHODS:

A total of 621 patients enrolled in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial with baseline quantitative nuclear single-photon emission computed tomography (SPECT) and quantitative coronary angiography were studied. Several multiple regression models were constructed to determine independent predictors of the endpoint of death, myocardial infarction (MI) (excluding periprocedural MI) and non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Ischemic burden during stress SPECT, anatomic burden derived from angiography, left ventricular ejection fraction, and assignment to either optimal medical therapy (OMT) + percutaneous coronary intervention (PCI) or OMT alone were analyzed.

RESULTS:

In nonadjusted and adjusted regression models, anatomic burden and left ventricular ejection fraction were consistent predictors of death, MI, and NSTE-ACS, whereas ischemic burden and treatment assignment were not. There was a marginal (p = 0.03) effect of the interaction term of anatomic and ischemic burden for the prediction of clinical outcome, but separately or in combination, neither anatomy nor ischemia interacted with therapeutic strategy to predict outcome.

CONCLUSIONS:

In a cohort of patients treated with OMT, anatomic burden was a consistent predictor of death, MI, and NSTE-ACS, whereas ischemic burden was not. Importantly, neither determination, even in combination, identified a patient profile benefiting preferentially from an invasive therapeutic strategy. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]; NCT00007657).

KEYWORDS:

angiographic burden; coronary angiography; ischemia; ischemic burden; nuclear perfusion imaging; stable ischemic heart disease

Comment in

PMID:
24440015
DOI:
10.1016/j.jcin.2013.10.017
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center