#77 Long-term outcomes of medical management of patients with chronic coronary artery disease

PURPOSE: Insufficient data exist on the long-term outcomes of optimized medical therapy in patients with chronic stable coronary artery disease (CAD), compared with outcomes among those undergoing coronary revascularization. METHODS: We followed prospectively 693 subjects with proven CAD using a management strategy that emphasized maximally tolerated medical therapy and risk factor modification. Exclusion criteria were class III-IV congestive heart failure, severe valvular disease or prior revascularization. Referral to invasive coronary interventions followed stricter criteria than standard guidelines. Primary outcomes were all-cause mortality or non-fatal myocardial infarction (MI). Secondary outcomes included cardiac death, unstable angina or revascularization. RESULTS: Baseline characteristics were: mean age 67 years, 82% males, 42% with prior MI and 6% current smokers. Mean ejection fraction and total cholesterol were 59% and 204 mg/dl, respectively. During an average follow-up of 4.6 years, the annualized incidence of non-fatal MI, cardiac and total mortality was 2.2%, 0.8%, 1.4%, respectively. Coronary revascularization was performed in 24% of subjects; unstable or progressive anginal symptoms were the most common reasons for revascularization. In multivariate analysis, the variables most predictive of adverse outcomes were: history of diabetes, RR 2.2 (1.4–3.4), prior MI, RR 1.5 (1.1–2.0), and age , RR 1.5 (1.2–1.9). Use of aspirin, beta blockers or lipid lowering agents was protective. CONCLUSION: In patients with chronic stable CAD, a management strategy based on optimized medical therapy and modification of risk factors, is associated with excellent long-term outcome and represents a viable alternative to invasive procedures. Coronary interventions can be avoided or delayed until clinical instability ensues, without increased risk of MI or death.