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    Long-term outcomes of optimized medical management of outpatients with stable coronary artery disease

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    Authors
    Jabbour, Samer
    Young-Xu, Yinong
    Graboys, Thomas B.
    Blatt, Charles M.
    Goldberg, Robert J.
    Bedell, Susanna E.
    Bilchik, Brian Z.
    Lown, Bernard
    Ravid, Shmuel
    UMass Chan Affiliations
    Department of Medicine, Division of Cardiovascular Medicine
    Document Type
    Journal Article
    Publication Date
    2004-02-05
    Keywords
    Adult
    Aged
    Aged, 80 and over
    *Ambulatory Care
    Angina Pectoris
    Coronary Artery Disease
    Female
    Follow-Up Studies
    Humans
    Male
    Middle Aged
    Myocardial Infarction
    *Patient-Centered Care
    Prospective Studies
    Time Factors
    Treatment Outcome
    Bioinformatics
    Biostatistics
    Epidemiology
    Health Services Research
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    Link to Full Text
    http://dx.doi.org/10.1016/j.amjcard.2003.10.007
    Abstract
    The objective of this study was to assess long-term clinical outcomes and their correlates in medically managed outpatients with stable angina pectoris, healed myocardial infarction (MI), or documented asymptomatic coronary artery disease (CAD). Management strategy emphasized maximally tolerated medical therapy and modification of coronary risk factors. Referral to invasive coronary interventions followed stricter criteria than standard published guidelines. Primary study outcomes were all-cause mortality or nonfatal myocardial infarction. Secondary study outcomes included cardiac death, unstable angina, or coronary revascularization. A total of 693 men and women with proved CAD (mean age 67 years at entry, 85% men, 41% with history of MI) were enrolled. The annual incidence of nonfatal MI, cardiac mortality, and total mortality was 2.2%, 0.8%, and 1.4%, respectively, during an average follow-up of 4.6 years. Coronary revascularization was performed in 24% of subjects; unstable or progressive anginal symptoms were the most common reasons for revascularization. In patients with documented stable CAD, a management strategy based on intensive medical therapy and modification of established coronary risk factors was associated with excellent long-term outcomes. Thus, coronary interventions can be safely delayed until clinical instability ensues, without increased risk of MI or death. This treatment approach represents a viable alternative to invasive strategies.
    Source
    Am J Cardiol. 2004 Feb 1;93(3):294-9. Link to article on publisher's site
    DOI
    10.1016/j.amjcard.2003.10.007
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/47177
    PubMed ID
    14759377
    Related Resources
    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.amjcard.2003.10.007
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    Population and Quantitative Health Sciences Publications

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