It has not been clearly established whether percutaneous coronary intervention ( PCI) can provide an incremental benefit in quality of life over that provided by. tee and the members of the COURAGE. Trial Executive Committee are provided in the Supplementary Appendix, avail- able at was evaluated in the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) trial, in which patients were randomly.
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We conducted a randomized trial involving patients who had objective evidence of myocardial ischemia and significant coronary artery disease at 50 U. All secondary outcomes and individual components of the primary outcomes showed no significant differences between the study groups. Knowing the coronary anatomy may have been a driver of early revascularization procedures in the medical therapy groups of both trials. Optimal medical therapy with or without percutaneous coronary intervention in women with stable coronary disease: Breaking News Cardiology Journal Club.
Also, survival advantage has been demonstrated for revascularization, and particularly with CABG for important patient subgroups—this is based mainly on anatomic features, despite stable symptomatology. Recruitment was halted prematurely after enrollment of patients randomized and enrolled nej the registry because of a significant between-group difference in the percentage of patients who had a primary endpoint event: In the NEJM paper, the researchers reported an unadjusted hazard ratio of 0.
The authors of nsjm study explain their results, in part, by the physiologic differences between vulnerable plaques tral rupture and are associated with acute coronary syndromes and more fibrous plaques that couragw cause luminal narrowing and anginal symptoms in patients with stable disease such as those in enrolled in this study.
Both of yrial study groups received optimization of medical therapy, including aspirin along with aggressive lipid and blood pressure lowering. This randomization process will reduce referral bias. Women Often Shortchanged Dr. Boden reports no relevant conflicts of interest.
However, women appeared to benefit more from PCI than men in terms of MI, hospitalization for heart failure, and need for subsequent revascularization table 1. N Engl J Med Mar 27; [pub ahead of print]. Chronic CAD patients usually develop collaterals and aggressive revascularization may risk reperfusion injury of the myocardium nemm adjusted to lower oxygen load.
At a median follow-up of 4.
Optimal medical therapy with or without PCI for stable coronary disease. There were primary events in the PCI group and events in the medical-therapy group. In summary, this study reveals that PCI offers no benefit over aggressive medical management when performed in patients with stable ttial artery disease, and suggests that PCI may be deferred in patients with stable disease as long as medical therapy is optimized and maintained. In both trials there was no difference between treatment groups in the incidence of death or MI.
What is particularly newsworthy about the FAME courxge results is that there was no difference in the rates of death or MI between treatment groups. The results of one of the more remarkable studies from the meeting of the American College of Cardiology were presented on Monday, along with the simultaneous early publishing of the study online in the New England Journal of Medicine. However, PCI did appear as if it might be particularly beneficial for women in terms of MI, hospitalization for heart failure, and need for subsequent revascularization.
The COURAGE Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial was a randomized trial involving patients with stable but significant coronary artery disease who were randomized to either undergo PCI using bare metal stents or to receive optimal medical therapy alone. In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention PCI with intensive pharmacologic therapy and lifestyle intervention optimal medical therapy is superior to optimal medical therapy alone in reducing the risk of cardiovascular events.
If other, please specify. Additionally, on the Seattle Angina Questionnaire SAQboth the angina-related physical limitation and the angina frequency scores indicated poorer health status at baseline in women. Patients in whom all stenoses had an Courahe of more than 0.
The COURAGE Trial: PCI is not superior to medical therapy in patients with stable coronary disease
As noted by Dr. Boden WE et al. What I find surprising is the triak reaction of many commentators. Two thirds of the patients had multi-vessel disease.
On the basis of FAME 2, one would need ttial perform PCI in stable patients to prevent 9 urgent revascularizations — only 4 of which have positive biomarkers or ECG trila — without reducing the incidence of death or MI.
Hospitalization for heart failure, even though it was not a prespecified endpoint, is an outcome of interest because it has been shown to powerfully predict adverse outcomes in patients with stable CAD and preserved ejection fraction, he commented. The primary outcome of the study was a composite outcome of death from any cause and non-fatal myocardial infarction. Comment in N Engl J Med. The new adjusted analysis, Dr. Nat Clin Pract Cardiovasc Med.
Fame 2 Update | The ISCHEMIA Study
Boden and colleagues compared outcomes by patient sex and treatment assignment after adjustment for relevant baseline characteristics.
The primary outcome was death from any cause and nonfatal myocardial infarction during a follow-up period of 2. Enter the email you used to register to reset your password. As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy.
You need to document perfusion defect with Myocardial Perfusion Imaging Stress Thallium as popularly known and of course take into account the clinical evaluation of the individual patient. Women also had higher LVEF, fewer diseased coronary vessels, and higher baseline HDL but worse kidney function and a slightly longer duration of angina.