Predicting Outcome in the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) Coronary Anatomy Versus Ischemia

被引：183

作者：

Mancini, G. B. John ^{[1
]}

Hartigan, Pamela M. ^{[2
]}

Shaw, Leslee J. ^{[3
]}

Berman, Daniel S. ^{[4
]}

Hayes, Sean W. ^{[4
]}

Bates, Eric R. ^{[5
]}

Maron, David J. ^{[6
]}

Teo, Koon ^{[7
]}

Sedlis, Steven P. ^{[8
]}

Chaitman, Bernard R. ^{[9
]}

Weintraub, William S. ^{[10
]}

Spertus, John A. ^{[11
]}

Kostuk, William J. ^{[12
]}

Dada, Marcin ^{[13
]}

Booth, David C. ^{[14
]}

Boden, William E. ^{[15
,16
]}

机构：

[1] Univ British Columbia, Vancouver, BC V5Z 1M9, Canada

[2] Connecticut VA Healthcare Syst, Vet Affairs Cooperat Studies Program, Coordinating Ctr, West Haven, CT USA

[3] Emory Univ, Sch Med, Atlanta, GA USA

[4] Univ Calif Los Angeles, Cedars Sinai Heart Inst, Los Angeles, CA USA

[5] Univ Michigan, Med Ctr, Ann Arbor, MI USA

[6] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[7] McMaster Univ, Med Ctr, Hamilton, ON, Canada

[8] NYU, Sch Med, VA New York Harbor Healthcare Syst, New York, NY USA

[9] St Louis Univ Hosp, St Louis, MO USA

[10] Christiana Care Hlth Syst, Newark, DE USA

[11] Univ Missouri, Mid Amer Heart Inst, Kansas City, MO 64110 USA

[12] Univ Western Ontario, London Hlth Sci Ctr, London, ON, Canada

[13] Hartford Hosp, Hartford, CT 06115 USA

[14] Univ Kentucky, Lexington, KY USA

[15] Buffalo Gen Hosp, New York Hlth Care Syst, Buffalo, NY 14203 USA

[16] SUNY Buffalo, Buffalo, NY 14260 USA

来源：

JACC-CARDIOVASCULAR INTERVENTIONS | 2014年 / 7卷 / 02期

基金：

加拿大健康研究院;

关键词：

angiographic burden; coronary angiography; ischemia; ischemic burden; nuclear perfusion imaging; stable ischemic heart disease; EMISSION COMPUTED-TOMOGRAPHY; OPTIMAL MEDICAL THERAPY; LEFT-VENTRICULAR FUNCTION; MYOCARDIAL-PERFUSION; ARTERY-DISEASE; HEART-DISEASE; CARDIOVASCULAR EVENTS; RESIDUAL RISK; INTERVENTION; SURVIVAL;

D O I：

10.1016/j.jcin.2013.10.017

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives The aim of this study was to determine the relative utility of anatomic and ischemic burden of coronary artery disease for predicting outcomes. Background Both anatomic burden and ischemic burden of coronary artery disease determine patient prognosis and influence myocardial revascularization decisions. When both measures are available, their relative utility for prognostication and management choice is controversial. Methods A total of 621 patients enrolled in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial with baseline quantitative nuclear single-photon emission computed tomography (SPECT) and quantitative coronary angiography were studied. Several multiple regression models were constructed to determine independent predictors of the endpoint of death, myocardial infarction (MI) (excluding periprocedural MI) and non-ST-segment elevation acute coronary syndromes (NSTE-ACS). Ischemic burden during stress SPECT, anatomic burden derived from angiography, left ventricular ejection fraction, and assignment to either optimal medical therapy (OMT) + percutaneous coronary intervention (PCI) or OMT alone were analyzed. Results In nonadjusted and adjusted regression models, anatomic burden and left ventricular ejection fraction were consistent predictors of death, MI, and NSTE-ACS, whereas ischemic burden and treatment assignment were not. There was a marginal (p = 0.03) effect of the interaction term of anatomic and ischemic burden for the prediction of clinical outcome, but separately or in combination, neither anatomy nor ischemia interacted with therapeutic strategy to predict outcome. Conclusions In a cohort of patients treated with OMT, anatomic burden was a consistent predictor of death, MI, and NSTE-ACS, whereas ischemic burden was not. Importantly, neither determination, even in combination, identified a patient profile benefiting preferentially from an invasive therapeutic strategy. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [ COURAGE]; NCT00007657) (C) 2014 by the American College of Cardiology Foundation

引用

页码：195 / 201

页数：7

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