title: Prognostic importance of coronary anatomy and left ventricular ejection fraction despite optimal therapy: assessment of residual risk in the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation Trial.
abstract: BACKGROUND
  It is unknown if baseline angiographic findings can be used to estimate residual risk of patients with chronic stable angina treated with both optimal medical therapy (OMT) and protocol-assigned or symptom-driven percutaneous coronary intervention (PCI).
  
  
  METHODS
  Death, myocardial infarction (MI), and hospitalization for non-ST-segment elevation acute coronary syndrome were adjudicated in 2,275 COURAGE patients. The number of vessels diseased (VD) was defined as the number of major coronary arteries with ≥50% diameter stenosis. Proximal left anterior descending, either isolated or in combination with other disease, was also evaluated. Depressed left ventricular ejection fraction (LVEF) was defined as ≤50%. Cox regression analyses included these anatomical factors as well as interaction terms for initial treatment assignment (OMT or OMT + PCI).
  
  
  RESULTS
  Percutaneous coronary intervention and proximal left anterior descending did not influence any outcome. Death was predicted by low LVEF (hazard ratio [HR] 1.86, CI 1.34-2.59, P < .001) and VD (HR 1.45, CI 1.20-1.75, P < .001). Myocardial infarction and non-ST-segment elevation acute coronary syndrome were predicted only by VD (HR 1.53, CI 1.30-1.81 and HR 1.24, CI 1.06-1.44, P = .007, respectively).
  
  
  CONCLUSIONS
  In spite of OMT and irrespective of protocol-assigned or clinically driven PCI, LVEF and angiographic burden of disease at baseline retain prognostic power and reflect residual risk for secondary ischemic events.
authors.affiliation: University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: mancini@mail.ubc.ca.
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Hartigan
authors.forename: Eric R
authors.initials: ER
authors.lastname: Bates
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Chaitman
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.forename: William J
authors.initials: WJ
authors.lastname: Kostuk
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.forename: Marcin
authors.initials: M
authors.lastname: Dada
authors.forename: Merril
authors.initials: M
authors.lastname: Knudtson
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: David C
authors.initials: DC
authors.lastname: Booth
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
mesh_terms: D000787:Angina Pectoris / Q000150:complications / Q000401:mortality / Q000628:therapy*; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012044:Regression Analysis; D018570:Risk Assessment; D013318:Stroke Volume; D016019:Survival Analysis