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COURAGE: Treatment effect on hospitalization for ACS Boden WE et al. N Engl J Med. 2007;356:1503-16. *Unadjusted HR 1.07 (0.84-1.37) P = 0.56* No. at risk Medical therapy PCI 127 134 236 246 418 431 662 667 833 835 956 957 1025 1027 1138 1149 Survival free of ACS Years 0 0 1 2 3 4 5 6 7 1.0 0.9 0.7 0.8 PCI + medical therapy Medical therapy COURAGE: Treatment effect on angina Boden WE et al. N Engl J Med. 2007;356:1503-16. P 0.001 P = 0.02 NS Angina-free (%) NS Boden WE et al. N Engl J Med. 2007;356:1503-16. Treatment effect in CV and diabetes subgroups 0.25 0.50 1.00 2.00 1.75 1.50 Medical therapy better PCI better Myocardial infarction Yes No Extent of CAD Multivessel disease Single-vessel disease Diabetes Yes No Angina CCS 0-I CCS II-III Ejection fraction 50% Previous CABG No Yes ≤50% Baseline characteristics Hazard ratio (95% CI) PCI + OMT compared to OMT resulted in: Significantly less use of nitrates at - 1 year (53% vs. 67%) - 3 years (47% vs. 61%) - 5 years (40% vs. 57%) Significantly less use of Ca+2 channel blockers at - 1 year (40% vs. 49%) - 3 years (43% vs. 50%) - 5 years (42% vs. 52%) Freedom from Anti-anginal Meds During Long-term Follow-up Despite a much higher than anticipated XO to PCI in the OMT group Boden WE et al. NEJM 2007;356:1503-16 Follow-up PCI + OMT OMT P Value Baseline 51 + 25 51 + 25 0.83 3 months 73 + 22 68 + 23 0.0001 6 months 73 + 23 70 + 23 0.0005 12 months 75 + 21 71 + 22 0.0006 24 months 76 + 21 74 + 22 0.11 36 months 77 + 21 75 + 22 0.05 SAQ Domain Quality of Life Boden and Weintraub, ACC 2007. 不适宜长期双重抗血小板治疗的情况 计划中的非心脏手术 支架血栓形成的高危患者 出血并发症风险增加 高龄，贫血，肾功能衰竭，消化道出血后， 低体重 需长期服口服抗凝剂者 房颤、肺栓塞、机械瓣置换术后 不愿意或不能长期按医嘱服药者 Summary Long-term efficacy of DES is persistent and the safety of DES is confirmed by meta-analysis based on patients level Late stent thrombosis after DES implantation has emerged as a concerning entity Indication for DES stenting Proper dual antiplatelet therapy, at least 1year
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