Optimal medical therapy with or without percutaneous coronary intervention in older patients with stable coronary disease: a pre-specified subset analysis of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation) trial.
OBJECTIVE
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 >or=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>or=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).
McMaster University Medical Center, Hamilton, Ontario, Canada.
Koon K
KK
Teo
Steven P
SP
Sedlis
William E
WE
Boden
Robert A
RA
O'Rourke
David J
DJ
Maron
Pamela M
PM
Hartigan
Marcin
M
Dada
Vipul
V
Gupta
John A
JA
Spertus
William J
WJ
Kostuk
Daniel S
DS
Berman
Leslee J
LJ
Shaw
Bernard R
BR
Chaitman
G B John
GB
Mancini
William S
WS
Weintraub
D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D001794:Blood Pressure; D015992:Body Mass Index; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000628:therapy*; D004032:Diet; D015444:Exercise; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D016540:Smoking Cessation; D020521:Stroke / Q000453:epidemiology
D002317:Cardiovascular Agents; D008077:Lipoproteins, LDL