Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Effect of PCI on Long-Term Survival

Outcomes in patients with stable ischemic HD

Publish date:: December 1, 2015

There was no difference in survival between an initial strategy of PCI plus medical therapy and medical therapy alone after extended 15-year follow-up in patients with stable ischemic heart disease, according to extended survival information for 1,211 patients. Median duration of follow-up for all patients was 6.2 years; the median duration of follow-up for patients at the sites that permitted survival tracking was 11.9 years.

Researchers found:

• 561 deaths occurred; 180 during the follow-up period in the original trial and 381 during the extended follow-up period.

• There were 284 deaths (25%) in the PCI group and 277 (24%) in the medical therapy group (aHR, 1.03).

Citation: Sedlis SP, Hartigan PM, Teo KK, et al. Effect of PCI on long-term survival in patients with stable ischemic heart disease. N Engl J Med. 2015;373:1937-1946. doi: 10.1056/NEJMoa1505532.

Commentary: The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial compared a strategy of optimal medical therapy for advanced coronary artery disease versus optimal medical therapy plus percutaneous coronary intervention (PCI) and found no difference in outcome between these 2 groups. This was a landmark trial and has influenced guidelines and changed the practice of interventional cardiology. The current study follows patients from the original COURAGE cohort for up to 15 years and continues to show no survival advantage in either group. In addition, no high-risk subgroup of patients has been identified that showed a survival benefit from PCI compared with optimal medical therapy alone in the original study or in the extended cohort. This study adds further evidence that PCI can be used for treatment of angina that does not respond to medical treatment but will not offer a survival advantage over optimal medical therapy. —Matthew Sorrentino, MD

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