Mancini G B John, Bates Eric R, Maron David J, Hartigan Pamela, Dada Marcin, Gosselin Gilbert, Kostuk William, Sedlis Steven P, Shaw Leslee J, Berman Daniel S, Berger Peter B, Spertus John, Mavromatis Kreton, Knudtson Merril, Chaitman Bernard R, O'Rourke Robert A, Weintraub William S, Teo Koon, Boden William E
Vancouver Hospital, Cardiovascular Imaging Research Core Laboratory, University of British Columbia, Vancouver, Canada.
Circ Cardiovasc Qual Outcomes. 2009 Jul;2(4):320-7. doi: 10.1161/CIRCOUTCOMES.108.830091. Epub 2009 Jun 2.
COURAGE compared outcomes in stable coronary patients randomized to optimal medical therapy plus percutaneous coronary intervention (PCI) versus optimal medical therapy alone.
Angiographic data were analyzed by treatment arm, health care system (Veterans Administration, US non-Veterans Administration, Canada), and gender. Veterans Administration patients had higher prevalence of coronary artery bypass graft surgery and left ventricular ejection fraction < or =50%. Men had worse diameter stenosis of the most severe lesion, higher prevalence of prior coronary artery bypass graft surgery, lower left ventricular ejection fraction, and more 3-vessel disease that included a proximal left anterior descending lesion (P<0.0001 for all comparisons versus women). Failure to cross rate (3%) and visual angiographic success of stent procedures (97%) were similar to contemporary practice in the National Cardiovascular Data Registry. Quantitative angiographic PCI success was 93% (residual lesion <50% in-segment) and 82% (<20% in-stent), with only minor nonsignificant differences among health care systems and genders. Event rates were higher in patients with higher jeopardy scores and more severe vessel disease, but rates were similar irrespective of treatment strategy. Within the PCI plus optimal medical therapy arm, complete revascularization was associated with a trend toward lower rate of death or nonfatal myocardial infarction. Complete revascularization was similar between genders and among health care systems.
PCI success and completeness of revascularization did not differ significantly by health care system or gender and were similar to contemporary practice. Angiographic burden of disease affected overall event rates but not response to an initial strategy of PCI plus optimal medical therapy or optimal medical therapy alone.
“临床结果利用介入治疗与药物评估对比研究”（COURAGE）比较了随机分配至最佳药物治疗联合经皮冠状动脉介入治疗（PCI）与单纯最佳药物治疗的稳定型冠心病患者的预后。
通过治疗组、医疗保健系统（退伍军人管理局、美国非退伍军人管理局、加拿大）和性别对血管造影数据进行分析。退伍军人管理局的患者冠状动脉旁路移植术患病率较高，左心室射血分数≤50%。男性最严重病变的直径狭窄更严重，既往冠状动脉旁路移植术患病率更高，左心室射血分数更低，三支血管病变更多，包括左前降支近端病变（与女性相比，所有比较的P<0.0001）。支架置入术的未通过率（3%）和血管造影视觉成功率（97%）与国家心血管数据注册中心的当代实践相似。定量血管造影PCI成功率为93%（节段内残余病变<50%）和82%（支架内<20%），医疗保健系统和性别之间只有微小的非显著差异。危险评分较高和血管疾病较严重的患者事件发生率较高，但无论治疗策略如何，发生率相似。在PCI联合最佳药物治疗组中，完全血运重建与死亡或非致命性心肌梗死发生率降低的趋势相关。完全血运重建在性别和医疗保健系统之间相似。
PCI成功率和血运重建的完整性在医疗保健系统或性别方面无显著差异，与当代实践相似。疾病的血管造影负担影响总体事件发生率，但不影响对PCI联合最佳药物治疗或单纯最佳药物治疗初始策略的反应。
