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

G. B.John Mancini, Pamela M. Hartigan, Eric R. Bates, Bernard R. Chaitman, Steven P. Sedlis, David J. Maron, William J. Kostuk, John A. Spertus, Koon K. Teo, Marcin Dada, Merril Knudtson, Daniel S. Berman, David C. Booth, William E. Boden, William S. Weintraub

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

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.

Original languageEnglish
Pages (from-to)481-487
Number of pages7
JournalAmerican Heart Journal
Volume166
Issue number3
DOIs
StatePublished - Sep 2013

Bibliographical note

Funding Information:
Funding was provided by the Cooperative Studies Program of the US Department of Veterans Affairs Office of Research and Development, in collaboration with the Canadian Institutes of Health Research, and by unrestricted research grants from Merck, Pfizer, Bristol- Myers Squibb, Fujisawa, Kos Pharmaceuticals, Datascope, AstraZeneca, Key Pharmaceutical, Sanofi-Aventis, First Horizon, and GE Healthcare, including in-kind support with Food and Drug Administration–approved drugs used by study participants. All industrial funding in support of the trial was directed through the US Department of Veterans Affairs. The authors are solely responsible for the design and conduct of this study, all study analyses, the drafting and editing of the manuscript, and its final contents.

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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