TY - JOUR
T1 - Comparison of Outcomes of Invasive or Conservative Management of Chronic Coronary Disease in Four Randomized Controlled Trials
AU - Mavromatis, Kreton
AU - Boden, William E.
AU - Maron, David J.
AU - Mancini, G. B.John
AU - Weintraub, William S.
AU - Gosselin, Gilbert
AU - Berman, Daniel S.
AU - Shaw, Leslee J.
AU - Spertus, John A.
AU - Hochman, Judith S.
N1 - Funding Information:
The authors would like to acknowledge Sara Langan and Nadia Gakou for their editorial assistance. ClinicalTrials.gov identifier: NCT 00007657, NCT00006305, NCT01132495, NCT01471522. Dr. Mavromatis was an investigator in COURAGE, BARI 2D, FAME 2, and ISCHEMIA. Dr. Boden was an investigator in COURAGE and ISCHEMIA; he also reports grants from the National Heart, Lung, and Blood Institute during the conduct of this study and from AbbVie, grants from Amarin, grants from Amgen, personal fees from Amgen, personal fees from the Cleveland Clinic Clinical Coordinating Center, and personal fees from Janssen, outside of the submitted work. Dr. Maron was an investigator in COURAGE and ISCHEMIA and reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Mancini was an investigator in COURAGE and ISCHEMIA and reports grant from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Weintraub was an investigator in COURAGE and ISCHEMIA and reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Gosselin was an investigator in COURAGE and ISCHEMIA and reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Berman was an investigator in COURAGE and ISCHEMIA and reports grants from National Heart, Lung, and Blood Institute during the conduct of the study; reports grants from GE, CSMC Heartflow, and Bayer; receives software royalties from Cedars-Sinai Medical Center outside the submitted work. Dr. Shaw was an investigator in COURAGE and ISCHEMIA and reports grants from National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Spertus was an investigator in COURAGE and ISCHEMIA and reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study, personal fees from Bayer, personal fees from Novartis, personal fees from AstraZeneca, personal fees from Amgen, personal fees from Janssen, personal fees from United Healthcare, and grants from American College of Cardiology outside the submitted work; in addition, Dr. Spertus has a patent copyright to SAQ with royalties paid and is part of the board of directors for the Blue Cross Blue Shield of Kansas City and Equity in Health Outcomes Sciences. Dr. Hochman is principal investigator for the ISCHEMIA trial for which, in addition to support from the National Heart, Lung, and Blood Institute grant, devices and medications were provided by Abbott Vascular, Medtronic, Inc. St. Jude Medical, Inc. Volcano Corporation; Arbor Pharmaceuticals, LLC, AstraZeneca Pharmaceuticals, LP, Merck Sharp & Dohme Corp. Omron Healthcare, Inc. and financial donations from Arbor Pharmaceuticals LLC and AstraZeneca Pharmaceuticals LP.
Funding Information:
Dr. Mavromatis was an investigator in COURAGE, BARI 2D, FAME 2, and ISCHEMIA. Dr. Boden was an investigator in COURAGE and ISCHEMIA; he also reports grants from the National Heart, Lung, and Blood Institute during the conduct of this study and from AbbVie, grants from Amarin, grants from Amgen, personal fees from Amgen, personal fees from the Cleveland Clinic Clinical Coordinating Center, and personal fees from Janssen, outside of the submitted work. Dr. Maron was an investigator in COURAGE and ISCHEMIA and reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Mancini was an investigator in COURAGE and ISCHEMIA and reports grant from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Weintraub was an investigator in COURAGE and ISCHEMIA and reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Gosselin was an investigator in COURAGE and ISCHEMIA and reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Berman was an investigator in COURAGE and ISCHEMIA and reports grants from National Heart, Lung, and Blood Institute during the conduct of the study; reports grants from GE, CSMC Heartflow, and Bayer; receives software royalties from Cedars-Sinai Medical Center outside the submitted work. Dr. Shaw was an investigator in COURAGE and ISCHEMIA and reports grants from National Heart, Lung, and Blood Institute during the conduct of the study. Dr. Spertus was an investigator in COURAGE and ISCHEMIA and reports grants from the National Heart, Lung, and Blood Institute during the conduct of the study, personal fees from Bayer, personal fees from Novartis, personal fees from AstraZeneca, personal fees from Amgen, personal fees from Janssen, personal fees from United Healthcare, and grants from American College of Cardiology outside the submitted work; in addition, Dr. Spertus has a patent copyright to SAQ with royalties paid and is part of the board of directors for the Blue Cross Blue Shield of Kansas City and Equity in Health Outcomes Sciences. Dr. Hochman is principal investigator for the ISCHEMIA trial for which, in addition to support from the National Heart, Lung, and Blood Institute grant, devices and medications were provided by Abbott Vascular, Medtronic, Inc., St. Jude Medical, Inc., Volcano Corporation; Arbor Pharmaceuticals, LLC, AstraZeneca Pharmaceuticals, LP, Merck Sharp & Dohme Corp., Omron Healthcare, Inc., and financial donations from Arbor Pharmaceuticals LLC and AstraZeneca Pharmaceuticals LP.
Publisher Copyright:
© 2022
PY - 2022/12/15
Y1 - 2022/12/15
N2 - Revascularization and medical therapy for chronic coronary disease have both evolved significantly over the last 50 years. A total of 4 contemporary randomized controlled trials— Clinical Outcomes Utilizing Revascularization and Aggressive drug Evaluation (COURAGE), Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D), Fractional Flow Reserve versus Angiography for Multivessel Evaluation 2 (FAME 2), and International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA)—have assessed the incremental benefit of revascularization when added to secondary prevention with intensive pharmacologic and lifestyle intervention. We reviewed these 4 seminal studies with the objective of marshaling evidence to better frame how these results should apply to clinical decision making. These studies differed in study design, end points, intensity of treatment, and revascularization techniques. Nevertheless, they all demonstrate similar rates of “hard” clinical events with invasive and conservative management, and varying degrees of benefit in angina-related quality of life with revascularization. In conclusion, although controversy persists concerning the role of revascularization because of differing interpretations of the clinical trial evidence, we contend that instead of being competing management strategies, invasive and conservative approaches are complementary.
AB - Revascularization and medical therapy for chronic coronary disease have both evolved significantly over the last 50 years. A total of 4 contemporary randomized controlled trials— Clinical Outcomes Utilizing Revascularization and Aggressive drug Evaluation (COURAGE), Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D), Fractional Flow Reserve versus Angiography for Multivessel Evaluation 2 (FAME 2), and International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA)—have assessed the incremental benefit of revascularization when added to secondary prevention with intensive pharmacologic and lifestyle intervention. We reviewed these 4 seminal studies with the objective of marshaling evidence to better frame how these results should apply to clinical decision making. These studies differed in study design, end points, intensity of treatment, and revascularization techniques. Nevertheless, they all demonstrate similar rates of “hard” clinical events with invasive and conservative management, and varying degrees of benefit in angina-related quality of life with revascularization. In conclusion, although controversy persists concerning the role of revascularization because of differing interpretations of the clinical trial evidence, we contend that instead of being competing management strategies, invasive and conservative approaches are complementary.
UR - http://www.scopus.com/inward/record.url?scp=85141105978&partnerID=8YFLogxK
U2 - 10.1016/j.amjcard.2022.09.008
DO - 10.1016/j.amjcard.2022.09.008
M3 - Review article
C2 - 36257844
AN - SCOPUS:85141105978
SN - 0002-9149
VL - 185
SP - 18
EP - 28
JO - American Journal of Cardiology
JF - American Journal of Cardiology
ER -