title: Angiographic disease progression and residual risk of cardiovascular events while on optimal medical therapy: observations from the COURAGE Trial.
abstract: BACKGROUND
  The extent to which recurrent events in patients with stable coronary artery disease is attributable to progression of an index lesion originally ≥50% diameter stenosis (DS) but not revascularized or originally <50% DS is unknown during optimal medical therapy (OMT).
  
  
  RESULTS
  In the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial, 205 patients assigned to OMT plus percutaneous coronary intervention (PCI) and 284 patients assigned to OMT only had symptom-driven angiograms suitable for analysis. Percentages of patients in the OMT+PCI and OMT-only cohorts with index lesions originally <50% DS were 30% and 32%, respectively; 20% and 68% had index lesions originally ≥50% DS. In both groups, index lesions originally <50% or ≥50% DS represented <4% and <25% of all such lesions, respectively. The only angiographic predictor of myocardial infarction or acute coronary syndrome was the number of lesions originally ≥50% DS that had not been revascularized (odds ratio, 1.15; confidence limits, 1.01-1.31; P<0.04).
  
  
  CONCLUSIONS
  Lesions originally <50% DS were index lesions in one third of patients referred for symptom-driven repeat angiography, but represented <4% of all such lesions. Nonrevascularized lesions originally ≥50% DS were more often index lesions in OMT-only patients, but still represented a minority (<25%) of all such lesions. These findings underscore the need for improved therapies to arrest plaque progression and reliable strategies for selecting stenoses warranting PCI.
authors: University of British Columbia, Vancouver Hospital Research Pavilion, 828 W. 10th Avenue, Vancouver, BC, Canada. mancini@mail.ubc.ca
authors: G B John
authors: GB
authors: Mancini
authors: Pamela M
authors: PM
authors: Hartigan
authors: Eric R
authors: ER
authors: Bates
authors: Steven P
authors: SP
authors: Sedlis
authors: David J
authors: DJ
authors: Maron
authors: John A
authors: JA
authors: Spertus
authors: Daniel S
authors: DS
authors: Berman
authors: William J
authors: WJ
authors: Kostuk
authors: Leslee J
authors: LJ
authors: Shaw
authors: William S
authors: WS
authors: Weintraub
authors: Koon K
authors: KK
authors: Teo
authors: Marcin
authors: M
authors: Dada
authors: Bernard R
authors: BR
authors: Chaitman
authors: Robert A
authors: RA
authors: O'Rourke
authors: William E
authors: WE
authors: Boden
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002317:Cardiovascular Agents