Abstract | OBJECTIVES: BACKGROUND: While older patients with CAD are at increased risk for cardiac events compared with younger patients, it is unclear whether PCI may mitigate this risk more effectively than OMT alone or, alternatively, may be associated with more complications. METHODS: We conducted a pre-specified analysis of outcomes in stable CAD patients stratified by age and randomized to PCI+OMT or OMT alone in the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation) trial. RESULTS: A total of 1,381 patients (60%) were <65 years of age (mean 56+/-6 years) and 904 patients (40%) were >or=65 years of age (mean 72+/-5 years). Achieved treatment targets for blood pressure, low-density lipoprotein cholesterol, adherence to diet and exercise, and angina-free status did not differ by age or treatment assignment. Among older patients, there was a 2- to 3-fold higher death rate, but similar rates of myocardial infarction, stroke, and major cardiac events compared with younger patients. The addition of PCI to OMT did not improve or worsen clinical outcomes in patients>or=65 years of age during a median 4.6 year follow-up. CONCLUSIONS: These data support adherence to American College of Cardiology/American Heart Association clinical practice guidelines that advocate OMT as an appropriate initial management strategy, regardless of age. (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE]; NCT00007657).
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Authors | Koon K Teo, Steven P Sedlis, William E Boden, Robert A O'Rourke, David J Maron, Pamela M Hartigan, Marcin Dada, Vipul Gupta, John A Spertus, William J Kostuk, Daniel S Berman, Leslee J Shaw, Bernard R Chaitman, G B John Mancini, William S Weintraub, COURAGE Trial Investigators |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 54
Issue 14
Pg. 1303-8
(Sep 29 2009)
ISSN: 1558-3597 [Electronic] United States |
PMID | 19778673
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
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Chemical References |
- Cardiovascular Agents
- Lipoproteins, LDL
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Topics |
- Aged
- Angina, Unstable
(epidemiology)
- Angioplasty, Balloon, Coronary
- Blood Pressure
- Body Mass Index
- Cardiovascular Agents
(therapeutic use)
- Combined Modality Therapy
- Coronary Artery Disease
(therapy)
- Diet
- Exercise
- Female
- Follow-Up Studies
- Hospitalization
(statistics & numerical data)
- Humans
- Lipoproteins, LDL
(blood)
- Male
- Myocardial Infarction
(epidemiology)
- Outcome Assessment, Health Care
- Smoking Cessation
- Stroke
(epidemiology)
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