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Gated myocardial perfusion single photon emission computed tomography in the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial, Veterans Administration Cooperative study no. 424

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Stress gated myocardial perfusion single photon emission computed tomography (gSPECT) is increasingly used before and after intercurrent therapeutic intervention and is the basis for ongoing evaluation in the Department of Veterans Affairs clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial.

Methods and Results

The COURAGE trial is a North American multicenter randomized clinical trial that enrolled 2287 patients to aggressive medical therapy vs percutaneous coronary intervention plus aggressive medical therapy. Three COURAGE nuclear substudies have been designed. The goals of substudy 0 are to examine the diagnostic accuracy of the extent and severity of inducible ischemia at baseline in COURAGE patients compared with patient symptoms and quantitative coronary angiography and to explore the relationship between inducible ischemia and the benefit from revascularization when added to medical therapy. Substudy 1 will correlate the extent and severity of provocative ischemia with the frequency, quality, and instability of recurrent symptoms in postcatheterization patients. Substudy 2 (n _ 300) will examine the usefulness of sequential gSPECT monitoring 6 to 18 months after therapeutic intervention. Together, these nuclear substudies will evaluate the role of gSPECT to determine the effectiveness of aggressive risk-factor modifications, lifestyle interventions, and anti-ischemic medical therapies with or without revascularization in reducing patients’ ischemic burdens.

Conclusions

The unfolding of evidence on the application of gSPECT in trials such as COURAGE defines a new era for nuclear cardiology. We hope the evidence that emerges from the COURAGE trial will further establish the role of nuclear imaging in the evidence-based management of patients with stable coronary disease.

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Author information

Authors and Affiliations

  1. Cedars-Sinai Medical Center, Room 1258, Taper Building, 8700 Beverly Blvd, 90048, Los Angeles, CA

    Leslee J. Shaw, Romalisa Miranda-Peats, Piotr Slomka, John Friedman, Sean W. Hayes & Daniel S. Berman

  2. Hartford Hospital, Hartford, Conn

    Gary V. Heller, Marcin Dada & William E. Boden

  3. South Texas Veterans Healthcare System and University of Texas Health Science Center at San Antonio, San Antonio, Tex

    Paul Casperson & Robert A. O’Rourke

  4. University of Rochester Medical Center, Rochester, NY

    Ronald Schwartz

  5. Christiana Medical Center, NY

    William S. Weintraub

  6. Vanderbilt University Medical Center, Nashville, Tenn

    David J. Maron

  7. Piedmont Hospital, NY

    Spencer King

  8. McMaster University, NY

    Koon Teo

  9. VA Connecticut Healthcare System, Conn, NY

    William E. Boden & Pamela Hartigan

Authors
  1. Leslee J. Shaw
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  2. Romalisa Miranda-Peats
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  4. John Friedman
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  12. Ronald Schwartz
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Corresponding author

Correspondence to Daniel S. Berman.

Additional information

The COURAGE trial was supported by the Cooperative Studies Program of the Department of Veterans Affairs Office of Research and Development in collaboration with the Canadian Institutes of Health Research. Unrestricted research grants were obtained from Merck & Co; Pfizer Pharmaceuticals; Bristol-Myers Squibb Medical Imaging; Astellas Pharma; Kos Pharmaceuticals; Data Scope; Astra Zeneca Pharmaceuticals; Astra-Zeneca-Canada; Schering-Plough Coorporation, Ltd; Sanofi-Aventis, Inc; First Horizon; and GE Healthcare. All industrial funding for this trial was directed through the Department of Veterans Affairs. Additional funding for this substudy was provided by grants to the Department of Veterans Affairs and Canadian Institutes of Health Research from Astellas Pharma and Bristol-Myers-Squibb Medical Imaging.

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Shaw, L.J., Miranda-Peats, R., Slomka, P. et al. Gated myocardial perfusion single photon emission computed tomography in the clinical outcomes utilizing revascularization and aggressive drug evaluation (COURAGE) trial, Veterans Administration Cooperative study no. 424. J Nucl Cardiol 13, 685–698 (2006). https://doi.org/10.1016/j.nuclcard.2006.06.134

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