title: Effect of PCI on Long-Term Survival in Patients with Stable Ischemic Heart Disease.
abstract: BACKGROUND
  Percutaneous coronary intervention (PCI) relieves angina in patients with stable ischemic heart disease, but clinical trials have not shown that it improves survival. Between June 1999 and January 2004, we randomly assigned 2287 patients with stable ischemic heart disease to an initial management strategy of optimal medical therapy alone (medical-therapy group) or optimal medical therapy plus PCI (PCI group) and did not find a significant difference in the rate of survival during a median follow-up of 4.6 years. We now report the rate of survival among the patients who were followed for up to 15 years.
  
  
  METHODS
  We obtained permission from the patients at the Department of Veterans Affairs (VA) sites and some non-VA sites in the United States to use their Social Security numbers to track their survival after the original trial period ended. We searched the VA national Corporate Data Warehouse and the National Death Index for survival information and the dates of death from any cause. We calculated survival according to the Kaplan-Meier method and used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics.
  
  
  RESULTS
  Extended survival information was available for 1211 patients (53% of the original population). The median duration of follow-up for all patients was 6.2 years (range, 0 to 15); the median duration of follow-up for patients at the sites that permitted survival tracking was 11.9 years (range, 0 to 15). A total of 561 deaths (180 during the follow-up period in the original trial and 381 during the extended follow-up period) occurred: 284 deaths (25%) in the PCI group and 277 (24%) in the medical-therapy group (adjusted hazard ratio, 1.03; 95% confidence interval, 0.83 to 1.21; P=0.76).
  
  
  CONCLUSIONS
  During an extended-follow-up of up to 15 years, we did not find a difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone in patients with stable ischemic heart disease. (Funded by the VA Cooperative Studies Program and others; COURAGE ClinicalTrials.gov number, NCT00007657.).
authors.affiliation: From the New York Veterans Affairs (VA) Healthcare Network, New York (S.P.S., J.D.L.), and Upstate New York VA Healthcare Network and Albany Medical College, Albany (W.E.B.) - all in New York; VA Connecticut Healthcare System, West Haven (P.M.H.) and Hartford Hospital, Hartford (M.D.) - both in Connecticut; McMaster University Medical Center, Hamilton, ON (K.K.T.), Vancouver Hospital and Health Sciences Center, Vancouver, BC (G.B.J.M.), and London Health Sciences Centre, London, ON (W.K.) - all in Canada; Stanford University Medical Center, Stanford, CA (D.J.M.); Mid-America Heart Institute, University of Missouri, Kansas City, Kansas City (J.A.S.); Saint Louis University School of Medicine, St. Louis (B.R.C.); Cedars-Sinai Medical Center, Los Angeles (D.B.); and Christiana Care Health System, Newark, DE (W.S.W.).
authors.forename: Steven P
authors.initials: SP
authors.lastname: Sedlis
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Hartigan
authors.forename: Koon K
authors.initials: KK
authors.lastname: Teo
authors.forename: David J
authors.initials: DJ
authors.lastname: Maron
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: G B John
authors.initials: GB
authors.lastname: Mancini
authors.forename: William
authors.initials: W
authors.lastname: Kostuk
authors.forename: Bernard R
authors.initials: BR
authors.lastname: Chaitman
authors.forename: Daniel
authors.initials: D
authors.lastname: Berman
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Lorin
authors.forename: Marcin
authors.initials: M
authors.lastname: Dada
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: William E
authors.initials: WE
authors.lastname: Boden
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D016016:Proportional Hazards Models; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs