Journal of Clinical Lipidology
Volume 1, Issue 6 , Pages 564-574 , December 2007

Management of stable patients with coronary heart disease: Clinical implications of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial

  • Todd M. Brown, MD

      Affiliations

    • Division of Cardiovascular Diseases, University of Alabama at Birmingham, LHRB 306, 701 19th Street South, Birmingham, AL 35294, USA
    • Health Services and Outcomes Research Training Program, University of Alabama at Birmingham, LHRB 306, 701 19th Street South, Birmingham, AL 35294, USA
    • Corresponding Author InformationCorresponding author.
    • ,
  • Vera Bittner, MD, MSPH

      Affiliations

    • Division of Cardiovascular Diseases, University of Alabama at Birmingham, LHRB 306, 701 19th Street South, Birmingham, AL 35294, USA

Received 9 October 2007 ,Accepted 15 October 2007.

References 

  1. Rosamond W, Flegal K, Friday G, et al. Heart Disease and Stroke Statistics–2007 Update (A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee). Circulation. 2007;115:e69–e171
  2. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). 2004;Available at www.acc.org/clinical/guidelines/stemi/index.pdf.
  3. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1–e157
  4. Gibbons RJ, Abrams J, Chatterjee K, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for the Management of Patients with Chronic Stable Angina). 2002. Available at www.acc.org/clinical/guidelines/stable/stable.pdf
  5. Lin GA, Dudley RA, Redberg RF. Cardiologists’ use of percutaneous coronary interventions for stable coronary artery disease. Arch Intern Med. 2007;167:1604–1609
  6. Feldman DN, Gade CL, Slotwiner AJ, et al. Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (<60, 60 to 80, and >80 years) (from the New York State Angioplasty Registry). Am J Cardiol. 2006;98:1334–1339
  7. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–1516
  8. Wharton TP, Umans VA, Peels HO. PCI for stable coronary disease. N Engl J Med. 2007;357:415
  9. Katritsis DG, Ioannidis JP. Percutaneous coronary intervention versus conservative therapy in nonacute coronary artery disease: a meta-analysis. Circulation. 2005;111:2906–2912
  10. The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group. Eleven-year survival in the Veterans Administration randomized trial of coronary bypass surgery for stable angina. N Engl J Med. 1984;311:1333–1339
  11. Coronary Artery Surgery Study (CASS) Principal Investigators and Associates. CASS: a randomized trial of coronary bypass surgery. Circulation. 1983;68:939–950
  12. Varnauskas E European Coronary Surgery Study Group. Twelve-year follow-up of survival in the randomized European Coronary Surgery Study. N Engl J Med. 1988;319:332–337
  13. Yusuf S, Zucker D, Peduzzi P, et al. Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet. 1994;344:563–570
  14. Hoffman SN, TenBrook JA, Wolf MP, Pauker SG, Salem DN, Wong JB. A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes. J Am Coll Cardiol. 2003;41:1293–1304
  15. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med. 1996;335:217–225
  16. The BARI Investigators. Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease: the Bypass Angioplasty Revascularization Investigation (BARI). Circulation. 1997;96:1761–1769
  17. Freemantle N, Cleland J, Young P, Mason J, Harrison J. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999;318:1730–1737
  18. The Heart Outcomes Prevention Evaluation Study Investigators. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342:145–153
  19. The EURopean Trial. On reduction of cardiac events with Perindopril in stable coronary Artery disease Investigators (Efficacy of perindopril in reduction of cardiovascular events among patients with stable coronary artery disease: randomised, double-blind, placebo-controlled, multicentre trial (the EUROPA study)). Lancet. 2003;362:782–788
  20. Rossouw JE. Lipid-lowering interventions in angiographic trials. Am J Cardiol. 1995;76:86C–92C
  21. Rodriguez-Granillo GA, Agostoni P, Garcia-Garcia HM, et al. Meta-analysis of the studies accessing temporal changes in coronary plaque volume using intravascular ultrasound. Am J Cardiol. 2007;99:5–10
  22. Nicholls SJ, Tuzcu EM, Sipahi I, et al. Statins, high-density lipoprotein cholesterol, and regression of coronary atherosclerosis. JAMA. 2007;297:499–508
  23. O’Keefe JH, Cordain L, Harris WH, Moe RM, Vogel R. Optimal low-density lipoprotein is 50 to 70 mg/dl. J Am Coll Cardiol. 2004;43:2142–2146
  24. Buchwald H, Matts JP, Fitch LL, et al. Changes in sequential coronary arteriograms and subsequent coronary events (Surgical Control of the Hyperlipidemias (POSCH) Group). JAMA. 1992;268:1429–1433
  25. Brown BG, Zhao X-Q, Sacco DE, Albers JJ. Lipid lowering and plaque regression: new insights into prevention of plaque disruption and clinical events in coronary disease. Circulation. 1993;87:1781–1791
  26. Schuler G, Hambrecht R, Schlierf G, et al. Regular physical exercise and low-fat diet: effects on progression of coronary artery disease. Circulation. 1992;86:1–11
  27. Gould KL, Matucci JP, Goldberg DI, et al. Short-term cholesterol lowering decreases size and severity of perfusion abnormalities by positron emission tomography after dipyridamole in patients with coronary artery disease. Circulation. 1994;89:1530–1538
  28. Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995;92:657–671
  29. Libby P. What have we learned about the biology of atherosclerosis? (The role of inflammation). Am J Cardiol. 2001;88(suppl):3J–6J
  30. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116:682–692
  31. Witt BJ, Jacobsen SJ, Weston SA, et al. Cardiac rehabilitation after myocardial infarction in the community. J Am Coll Cardiol. 2004;44:988–996
  32. Wilt TJ, Bloomfield HE, MacDonald R, et al. Effectiveness of statin therapy in adults with coronary heart disease. Arch Intern Med. 2004;164:1427–1436
  33. Afilalo J, Majdan AA, Eisenberg MJ. Intensive statin therapy in acute coronary syndromes and stable coronary heart disease: a comparative meta-analysis of randomised controlled trials. Heart. 2007;93:914–921
  34. Hambrecht R, Walther C, Mobius-Winkler S, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease. Circulation. 2004;109:1371–1378
  35. Pitt B, Waters D, Brown WV, et al. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease. N Engl J Med. 1999;341:70–76
  36. The Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med. 1997;336:153–162
  37. Knatterud GL, Rosenberg Y, Campeau L, et al. Long-term effects on clinical outcomes of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation in the Post Coronary Artery Bypass Graft Trial. Circulation. 2000;102:157–165
  38. Sdringola S, Nakagawa K, Nakagawa K, et al. Combined intensive lifestyle and pharmacologic lipid treatment further reduce coronary events and myocardial perfusion abnormalities compared with usual-care cholesterol-lowering drugs in coronary artery disease. J Am Coll Cardiol. 2003;41:263–272
  39. Sdringola S, Loghin C, Boccalandro F, Gould KL. Mechanisms of progression and regression of coronary artery disease by PET related to treatment intensity and clinical events at long-term follow-up. J Nucl Med. 2006;47:59–67
  40. LaRosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352:1425–1435
  41. Shah AP, Shavelle DM, French WJ. PCI for stable coronary disease. N Engl J Med. 2007;357–415
  42. Kiat H. PCI for stable coronary disease. N Engl J Med. 2007;357–416
  43. Shaw LJ, Heller GV, Casperson P, et al. Gated myocardial perfusion single photon emission computed tomography in the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial, Veterans Administration Cooperative study no. 424. J Nucl Cardiol. 2006;13:685–698
  44. Nagajothi N, Velazquez-Cecena J-L, Khosla S. PCI for stable coronary disease. N Engl J Med. 2007;357:416–417
  45. Boden WE, Teo KK, Weintraub WS. PCI for stable coronary disease. N Engl J Med. 2007;357:417–418
  46. Kereiakes DJ, Teirstein PS, Sarembock IJ, et al. The truth and consequences of the COURAGE trial. J Am Coll Cardiol. 2007;50:1598–1603
  47. Weintraub WS. Presented at the American College of Cardiology Annual Scientific Sessions, New Orleans, LA, March 2007. Available at http://www.medscope.com/viewarticle/554223November 12, 2007
  48. Kereiakes DJ. PCI is no better than medical therapy for stable angina? (Seeing is not believing). Cleve Clin J Med. 2007;74:637–642
  49. Boden WE. It takes COURAGE to alter our belief system. Cleve Clin J Med. 2007;74:623–633
  50. The BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol. 2007;49:1600–1606
  51. Ford ES, Ajani UA, Croft JB, et al. Explaining the decrease in US deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–2398
  52. DeServi S. PCI for stable coronary disease. N Engl J Med. 2007;357–416
  53. Mak K-H. PCI for stable coronary disease. N Engl J Med. 2007;357–417

PII: S1933-2874(07)00291-7

doi: 10.1016/j.jacl.2007.10.009

Journal of Clinical Lipidology
Volume 1, Issue 6 , Pages 564-574 , December 2007

Article Tools

* Image Usage & Resolution