title: Effect of baseline exercise capacity on outcomes in patients with stable coronary heart disease (a post hoc analysis of the clinical outcomes utilizing revascularization and aggressive drug evaluation trial).
abstract: The impact of baseline exercise capacity on clinical outcomes in patients with stable ischemic heart disease randomized to an initial strategy of optimal medical therapy (OMT) with or without percutaneous coronary intervention (PCI) in the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial has not been studied. A post hoc analysis was performed in 1,052 patients of COURAGE (PCI + OMT: n = 527, OMT: n = 525) who underwent exercise treadmill testing at baseline. Patients were categorized into 2 exercise capacity groups based on metabolic equivalents (METs) achieved during baseline exercise treadmill testing (<7 METs: n = 464, ≥7 METs: n = 588) and were followed for a median of 4.6 years. The primary composite end point of death or myocardial infarction was similar in the PCI + OMT group and the OMT group for patients with exercise capacity <7 METs (19.1% vs 16.1%, p = 0.31) and ≥7 METs (13.3% vs 10.3%, p = 0.27). After adjusting for baseline covariates, the hazard ratio (99% confidence interval) for the primary end point for the PCI + OMT group versus the OMT group was 1.42 (0.90 to 2.23, p = 0.05) and for the exercise capacity subgroups of ≥7 METs and <7 METs was 0.75 (0.46 to 1.22, p = 0.13). There was no statistically significant interaction between the original treatment arm allocation (PCI + OMT vs OMT) and baseline exercise capacity. In conclusion, there was no difference in the long-term clinical outcomes in patients with exercise capacity <7 METs compared with ≥7 METs, irrespective of whether they were assigned to initial PCI. Patients with exercise capacity <7 METs did not derive a proportionately greater clinical benefit from PCI + OMT compared with those patients who received OMT alone.
authors.affiliation: Department of Medicine, Albany Medical Center, Albany, New York.
authors.forename: Santosh K
authors.initials: SK
authors.lastname: Padala
authors.affiliation: Department of Medicine, Albany Medical Center, Albany, New York; Department of Medicine, Samuel S. Stratton VA Medical Center and Albany Medical College, Albany, New York.
authors.forename: Mandeep S
authors.initials: MS
authors.lastname: Sidhu
authors.affiliation: Cooperative Studies Program Coordinating Center, VA Connecticut, West Haven, Connecticut.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Hartigan
authors.affiliation: Department of Medicine, Stanford University, Stanford, California.
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.affiliation: Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.affiliation: Department of Medicine, Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.affiliation: Department of Medicine, VA New York Harbor, New York University School of Medicine, New York, New York.
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
authors.affiliation: Department of Medicine, St. Louis University, St. Louis, Missouri.
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Chaitman
authors.affiliation: Department of Medicine, Intersocietal Accreditation Commission, Elicott City, Maryland.
authors.forename: Gary V
authors.initials: GV
authors.lastname: Heller
authors.affiliation: Department of Medicine, Christiana Care Health System, Newark, Delaware.
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.affiliation: Department of Medicine, Albany Medical Center, Albany, New York; Department of Medicine, Samuel S. Stratton VA Medical Center and Albany Medical College, Albany, New York. Electronic address: william.boden@va.gov.
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents