February 1, 2019Circulation Cardiovascular Quality and Outcomes
Effect of Coronary Anatomy and Myocardial Ischemia on Long-Term Survival in Patients with Stable Ischemic Heart Disease
Key result
Percutaneous coronary intervention offered no survival advantage over optimal medical therapy (HR 0.95; 95% CI 0.77-1.16), and neither angiographic nor ischemic severity predicted adjusted mortality.
Why the study?
The severity of CAD and of ischemia are evaluated to guide therapy, but their relative prognostic importance remains uncertain.
Does percutaneous coronary intervention improve long-term survival compared to optimal medical therapy in patients with stable ischemic heart disease, and do coronary anatomy or ischemia severity predict survival?
Population
767 COURAGE trial patients with stress perfusion imaging and quantitative coronary angiography
Comparison
PCI vs optimal medical therapy, across CAD and ischemia severity
Design
Extended survival follow-up of a randomized trial cohort
Follow-up
Median 7.9 years (range, 0-15 years)
Authors
Discussion
Loading...
Member takes
Implication
Reinforces deferral of PCI for survival in stable IHD; leaves open ischemia severity's prognostic role in randomized settings.
Study Design
Type
RCT (n=767)
Multicenter
Yes
Structured PICO
Does percutaneous coronary intervention improve long-term survival compared to optimal medical therapy in patients with stable ischemic heart disease, and do coronary anatomy or ischemia severity predict survival?
P
Population
767 patients with stable ischemic heart disease from the COURAGE trial with available stress perfusion imaging and quantitative coronary angiography, followed for a median of 7.9 years.
I
Intervention
Percutaneous coronary intervention added to optimal medical therapy
C
Comparator
Optimal medical therapy alone
O
Outcome
All-cause death (long-term survival)hard clinical
Main Result
Hazard Ratio: 0.95 (95% CI 0.77–1.16)
In patients with stable ischemic heart disease, neither the severity of ischemia nor the number of diseased coronary arteries predicted long-term mortality after adjustment, and PCI provided no survival benefit over optimal medical therapy.
Cite This Study
Weintraub et al. (2019) conducted an RCT in Stable Ischemic Heart Disease (n=767). Percutaneous coronary intervention vs. optimal medical therapy was evaluated on all-cause mortality (HR 0.95, 95% CI 0.77-1.16). Percutaneous coronary intervention offered no survival advantage over optimal medical therapy (HR 0.95; 95% CI 0.77-1.16), and neither angiographic nor ischemic severity predicted adjusted mortality.