Quantitative results of baseline angiography and percutaneous coronary intervention in the COURAGE trial.
BACKGROUND
COURAGE compared outcomes in stable coronary patients randomized to optimal medical therapy plus percutaneous coronary intervention (PCI) versus optimal medical therapy alone.


RESULTS
Angiographic data were analyzed by treatment arm, health care system (Veterans Administration, US non-Veterans Administration, Canada), and gender. Veterans Administration patients had higher prevalence of coronary artery bypass graft surgery and left ventricular ejection fraction < or =50%. Men had worse diameter stenosis of the most severe lesion, higher prevalence of prior coronary artery bypass graft surgery, lower left ventricular ejection fraction, and more 3-vessel disease that included a proximal left anterior descending lesion (P<0.0001 for all comparisons versus women). Failure to cross rate (3%) and visual angiographic success of stent procedures (97%) were similar to contemporary practice in the National Cardiovascular Data Registry. Quantitative angiographic PCI success was 93% (residual lesion <50% in-segment) and 82% (<20% in-stent), with only minor nonsignificant differences among health care systems and genders. Event rates were higher in patients with higher jeopardy scores and more severe vessel disease, but rates were similar irrespective of treatment strategy. Within the PCI plus optimal medical therapy arm, complete revascularization was associated with a trend toward lower rate of death or nonfatal myocardial infarction. Complete revascularization was similar between genders and among health care systems.


CONCLUSIONS
PCI success and completeness of revascularization did not differ significantly by health care system or gender and were similar to contemporary practice. Angiographic burden of disease affected overall event rates but not response to an initial strategy of PCI plus optimal medical therapy or optimal medical therapy alone.
Mancini
G B John
GB
Vancouver Hospital, Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, Canada. mancini@interchange.ubc.ca
Bates
Eric R
ER
Maron
David J
DJ
Hartigan
Pamela
P
Dada
Marcin
M
Gosselin
Gilbert
G
Kostuk
William
W
Sedlis
Steven P
SP
Shaw
Leslee J
LJ
Berman
Daniel S
DS
Berger
Peter B
PB
Spertus
John
J
Mavromatis
Kreton
K
Knudtson
Merril
M
Chaitman
Bernard R
BR
O'Rourke
Robert A
RA
Weintraub
William S
WS
Teo
Koon
K
Boden
William E
WE
D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality*; D002170:Canada / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography / Q000401:mortality*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012720:Severity of Illness Index; D017678:Sex Distribution; D015607:Stents / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
D002317:Cardiovascular Agents