Abstract 11925: Effects of Optimal Medical Therapy on Health Status in Patients With or Without PCI for Stable Coronary Disease: Results From COURAGE
Background: Health status data were measured repeatedly over time in the COURAGE trial, where percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) was compared with OMT alone in reducing the risk of cardiovascular events in patients with stable coronary disease. In this study, we examined the effects of OMT on health status data.
Methods: Health status was assessed with the RAND-36 and Seattle Angina Questionnaire (SAQ) at baseline, 1, 3, 6 month and annually among 2,287 patients followed for a median of 4.6 years. Medical therapy was based on guidelines for management of angina. Exercises status was evaluated via intensity and frequency of physical activity (30 to 45 minutes, 5 times/week). The nutrition status was assessed via MEDFICTS in term of the dietary goal of <7% of calories from saturated fat (score <40 vs. ≥40). Piece-wise growth curve modeling was conducted to study the factors associated with health status score changes.
Results: The health status scores in both groups had a significant 15~25% increase from baseline in each domain. The growth curve form for each domain is three-piece linear with a steep upward trajectory from baseline to 3 months, followed by a slight downward slope from 3 to 12 months, and remained stable from 12 to 60 months. Patients with good exercise status had 2 to 7 point higher increase in domain scores compared to those without good status; similar results were seen for nutrition status, and the use of aspirin/clopidogrel (See Table). Patients undergoing PCI+OMT had 1.9 to 2.8 point higher SAQ domain scores compared to OMT, but this disappeared after about 1 year and there was no significant difference between arms in 4 domains of the RAND36.
Conclusions: OMT, including exercise, nutrition status, the use of nitrates and aspirin/clopidogrel, were significant predictors of health status, adjusted by demographic/clinical conditions. Adding PCI to OMT had significant but small effect in some domains that quickly vanished.
Author Disclosures: Z. Zhang: None. P. Kolm: None. E. Ewen: None. J.A. Spertus: None. W.E. Boden: None. W.S. Weintraub: None.
- © 2014 by American Heart Association, Inc.