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Comparison of Characteristics and Outcomes of Veterans With Stable Ischemic Heart Disease Enrolled in the COURAGE Trial Versus the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program.

Authors :
Smilowitz NR
Carey EP
Shah B
Hartigan PM
Plomondon ME
Maron DJ
Maddox TM
Spertus JA
Mancini GBJ
Chaitman BR
Weintraub WS
Sedlis SP
Boden WE
Source :
The American journal of cardiology [Am J Cardiol] 2022 Oct 01; Vol. 180, pp. 1-9. Date of Electronic Publication: 2022 Jul 30.
Publication Year :
2022

Abstract

Randomized clinical trials have not demonstrated a survival benefit with percutaneous coronary intervention in stable ischemic heart disease (SIHD). We evaluated the generalizability of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial findings to the broader population of veterans with SIHD. Veterans who underwent coronary angiography between 2005 and 2013 for SIHD were identified from the Veterans Affairs Clinical Assessment, Reporting and Tracking Program (VA CART). Patient-level comparisons were made between patients from VA CART who met the eligibility criteria for COURAGE and veterans enrolled in COURAGE between 1999 and 2004. All-cause mortality over long-term follow-up was assessed using Cox proportional hazards models. COURAGE-eligible patients from VA CART (n = 59,758) were older, had a higher body mass index, a greater prevalence of co-morbidities, but fewer diseased vessels on index coronary angiography, and were less likely to be on optimal medical therapy at baseline and on 1-year follow-up compared with VA COURAGE participants (n = 968). Patients from VA CART (median follow-up 6.5 years) had higher all-cause mortality (adjusted hazard ratio [aHR] 1.98 [1.61 to 2.43]) than participants from VA COURAGE (median follow-up: 4.6 years). Risks of mortality were greater in the 56.4% patients from CART who were medically managed (aHR 1.94 [1.49 to 2.53]) and in the 43.6% who underwent percutaneous coronary intervention (aHR 1.99 [1.45 to 2.74]), compared with their respective VA COURAGE arms. In conclusion, in this noncontemporaneous patient-level analysis, veterans in the randomized COURAGE trial had more favorable outcomes than the population of veterans with SIHD at large.<br />Competing Interests: Disclosures Dr. Smilowitz serves on an advisory board for Abbott Vascular. Dr. Shah serves on an advisory board for Philips Volcano and Terumo Medical. The remaining authors have no conflicts of interest to declare.<br /> (Published by Elsevier Inc.)

Details

Language :
English
ISSN :
1879-1913
Volume :
180
Database :
MEDLINE
Journal :
The American journal of cardiology
Publication Type :
Academic Journal
Accession number :
35918234
Full Text :
https://doi.org/10.1016/j.amjcard.2022.06.049