Abstract 6226: Baseline Physical Limitation is Related to Death and MI in the COURAGE Trial
Purpose: In the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial, 2,287 patients were randomized to percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) or OMT alone. There was no difference between treatment groups with respect to event rates of the primary outcome, death or nonfatal myocardial infarction (MI) at 4.6 years of follow-up. The purpose of this study was to assess whether baseline physical limitation, a powerful independent predictor of survival in coronary disease, impacted the primary event rate.
Methods: Physical limitation was assessed by the Seattle Angina Questionnaire with patients grouped by terciles of baseline scores. Lower terciles are associated with greater physical limitation. Event rates were analyzed by Cox proportional hazards regression; comparisons between treatment arms were made with the log-rank test.
Results: There was a statistically significant increase in event rates from highest to middle tercile and from middle to lowest tercile (p <0.001 for each comparison). Patients in the lowest tercile were 1.7 times more likely to experience an event than patients in the middle tercile and 2.2 times more likely than patients in the highest tercile. At 4.6 years of follow-up, the estimated cumulative event rates were 0.27 for the lowest tercile (scores less than 53), 0.19 for the middle (scores 53–83), and 0.13 for the highest (scores >83) with no significant difference between PCI+OMT and OMT alone (Figure⇓).
Conclusions: Baseline physical limitation due to angina predicts death or nonfatal MI regardless of whether PCI is added to medical therapy.