000			03934nam a22003617a 4500
008			180619s20182018 xxu||||| |||| 00| 0 eng d
022			_a1941-7713
024			_a10.1161/CIRCOUTCOMES.117.003971 [doi]
024			_aCIRCOUTCOMES.117.003971 [pii]
040			_aOvid MEDLINE(R)
099			_a29752388
245			_aPredicting the Benefits of Percutaneous Coronary Intervention on 1-Year Angina and Quality of Life in Stable Ischemic Heart Disease: Risk Models From the COURAGE Trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation).
251			_aCirculation. Cardiovascular Quality & Outcomes. 11(5):e003971, 2018 May.
252			_aCirc Cardiovasc Qual Outcomes. 11(5):e003971, 2018 May.
253			_aCirculation. Cardiovascular quality and outcomes
260			_c2018
260			_fFY2018
266			_d2018-06-19
520			_aBACKGROUND: Percutaneous coronary intervention (PCI) is a therapy to reduce angina and improve quality of life in patients with stable ischemic heart disease. However, it is unclear whether the quality of life after PCI is more dependent on the PCI or other patient-related factors. To address this question, we created models to predict angina and quality of life 1 year after PCI and medical therapy.
520			_aCLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00007657.
520			_aCONCLUSIONS: The health status outcomes of stable ischemic heart disease patients treated by OMT+PCI versus OMT alone can be predicted with modest accuracy. Angina and quality of life at 1 year is improved by PCI but is more strongly associated with other patient characteristics.
520			_aCopyright (c) 2018 American Heart Association, Inc.
520			_aMETHODS AND RESULTS: Using data from the 2287 stable ischemic heart disease patients randomized in the COURAGE trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) to PCI plus optimal medical therapy (OMT) versus OMT alone, we built prediction models for 1-year Seattle Angina Questionnaire angina frequency, physical limitation, and quality of life scores, both as continuous outcomes and categorized by clinically desirable states, using multivariable techniques. Although most patients improved regardless of treatment, marked variability was observed in Seattle Angina Questionnaire scores 1 year after randomization. Adding PCI conferred a greater mean improvement (about 2 points) in Seattle Angina Questionnaire scores that were not affected by patient characteristics (P values for all interactions >0.05). The proportion of patients free of angina or having very good/excellent physical limitation (physical function) or quality of life at 1 year was 57%, 58%, 66% with PCI+OMT and 50%, 55%, 59% with OMT alone group, respectively. However, other characteristics, such as baseline symptoms, age, diabetes mellitus, and the magnitude of myocardium subtended by narrowed coronary arteries were as, or more, important than revascularization in predicting symptoms (partial R<sup>2</sup>=0.07 versus 0.29, 0.03 versus 0.22, and 0.05 versus 0.24 in the domain of angina frequency, physical limitation, and quality of life, respectively). There was modest/good discrimination of the models (C statistic=0.72-0.82) and excellent calibration (coefficients of determination for predicted versus observed deciles=0.83-0.97).
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aOutcomes Research
657			_aJournal Article
700			_aWeintraub, William S
790			_aBerman D, Boden WE, Hartigan P, Jones P, Kostuk W, Mancini GBJ, Maron DJ, Sedlis S, Spertus JA, Teo K, Weintraub WS, Zhang Z
856			_uhttps://dx.doi.org/10.1161/CIRCOUTCOMES.117.003971 _zhttps://dx.doi.org/10.1161/CIRCOUTCOMES.117.003971
942			_cART _dArticle
999			_c3423 _d3423