title: The evolving pattern of symptomatic coronary artery disease in the United States and Canada: baseline characteristics of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial.
abstract: Major improvements in medical therapy and percutaneous coronary intervention for coronary artery disease (CAD) have emerged during the previous 2 decades, but no randomized trial in patients with stable CAD has been powered to compare these 2 strategies for the hard clinical end points of death or myocardial infarction (MI), and previous studies have not evaluated the effect of coronary stents and intensive medical therapy on cardiac events during long-term follow-up. Between 1999 and 2004, 2,287 patients with documented myocardial ischemia and angiographically confirmed CAD were randomized to the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial, with a principal hypothesis that a strategy of percutaneous coronary intervention plus intensive, guideline-driven medical therapy would be superior to a strategy of intensive medical therapy alone. The primary end point was a composite of all-cause mortality or acute MI (time to first event) during a 2.5- to 7-year (median 5) follow-up. Baseline characteristics were a mean age of 62 +/- 5 years, 85% men, and 86% Caucasian. Mean duration of angina before randomization was 26 months (average 10 episodes/week), and 29% of patients were smokers, 67% had hypertension, 38% had previous MI, 71% had dyslipidemia, 34% had diabetes, 27% had previous revascularization, and 69% had multivessel CAD. Approximately 55% of patients met established criteria for the metabolic syndrome. In conclusion, baseline characteristics of the COURAGE trial study population indicate a highly symptomatic group of patients with CAD who have a significant duration and frequency of antecedent angina pectoris and a high prevalence of cardiac risk factors.
authors.affiliation: VA Connecticut Healthcare System, West Haven, Connecticut, USA. wboden@kaleidahealth.org
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.forename: Robert A
authors.initials: RA
authors.lastname: O'rourke
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Hartigan
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.forename: William
authors.initials: W
authors.lastname: Kostuk
authors.forename: Merril
authors.initials: M
authors.lastname: Knudtson
authors.forename: Marcin
authors.initials: M
authors.lastname: Dada
authors.forename: Paul
authors.initials: P
authors.lastname: Casperson
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Harris
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Leslee
authors.initials: L
authors.lastname: Shaw
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Chaitman
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Gerald
authors.initials: G
authors.lastname: Gau
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D002170:Canada / Q000453:epidemiology; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents