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Predicting outcome in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug

G B John Mancini1, Pamela M Hartigan2, Leslee J Shaw3

  • 1University of British Columbia, Vancouver, British Columbia, Canada.

JACC. Cardiovascular Interventions
|January 21, 2014
PubMed

Insights

Anatomic burden, not ischemic burden, consistently predicts outcomes in coronary artery disease patients receiving optimal medical therapy. Neither measure identified patients benefiting from invasive strategies.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Interventional Cardiology

Background:

  • Coronary artery disease (CAD) prognosis is influenced by both anatomic and ischemic burden.
  • The comparative prognostic value of these measures and their impact on revascularization decisions remain debated.

Purpose of the Study:

  • To compare the predictive utility of anatomic versus ischemic burden of CAD for patient outcomes.
  • To assess if either measure identifies patients who benefit from invasive treatment strategies.

Main Methods:

  • Analysis of 621 patients from the COURAGE trial with baseline SPECT and coronary angiography.
  • Multiple regression models used to identify predictors of death, myocardial infarction (MI), and non-ST-segment elevation acute coronary syndromes (NSTE-ACS).
  • Evaluated anatomic burden, ischemic burden, ejection fraction, and treatment strategy (OMT + PCI vs. OMT alone).

Main Results:

  • Anatomic burden and ejection fraction were consistent predictors of adverse events (death, MI, NSTE-ACS).
  • Ischemic burden and treatment assignment did not independently predict outcomes.
  • No significant interaction found between burden measures and treatment strategy for outcome prediction.

Conclusions:

  • In patients managed with optimal medical therapy (OMT), anatomic burden is a significant predictor of adverse cardiovascular events.
  • Ischemic burden did not predict outcomes in this cohort.
  • Neither anatomic nor ischemic burden, alone or combined, identified subgroups benefiting from percutaneous coronary intervention (PCI).
Abstract

Keywords:
angiographic burdencoronary angiographyischemiaischemic burdennuclear perfusion imagingstable ischemic heart disease

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