- Question
- Does a comprehensive strategy combining intensive lifestyle modification, medical treatment and revascularization reserved for severely reduced PET coronary flow capacity (CFC) reduce death, myocardial infarction and revascularization compared with standard community care in chronic coronary artery disease?
- Design
- Randomized, single-masked trial of 1028 participants (515 to comprehensive care and 513 to standard care), with a 5-year protocol and additional non-predefined follow-up of 5 to 11 years. Sponsored by the University of Texas Health Science Center, Houston.
- Population
- Participants with high risk factor burden and suspected or known coronary artery disease.
- Intervention
- Comprehensive care: review of rest-stress PET results with frequent clinic visits, open 24/7 phone/email support, intensive lifestyle modification, medical treatment, and revascularization reserved for severely reduced CFC.
- Control
- Standard community care directed by the referring cardiologist, without supportive contact; PET results were blinded except for severely reduced CFC with high mortality risk, which was unblinded for potential revascularization.
- Primary outcome
- Death, myocardial infarction and revascularization at 2, 5 and 10 years (clinical endpoints); PET CFC was quantified at baseline and at 2 and 5 years.
- Results
- Comprehensive care reduced the summed risk factor score at 5 years (P < 0.0001), all-cause death (4.7% vs. 8.2%; P = 0.023), death or MI (7.0% vs. 11.1%; P = 0.024), late revascularization (9.6% vs. 14.8%; P = 0.011) and major adverse cardiac events (20.5% vs. 29.9%; P = 0.0006).
- Safety
- Only 56 of 1028 patients (5.4%) underwent revascularization within 90 days guided by CFC severity, allowing preventive risk factor goals to be pursued safely.
- Conclusion
- A comprehensive strategy of intensive lifestyle modification and optimal medical treatment, reserving revascularization for severely reduced CFC, reduced death, death or MI, and revascularization at 5 years.
- Why it matters
- It supports an integrated, physiology-guided approach to chronic coronary disease in which intensive risk factor control is central and angiography and revascularization are reserved for the highest-risk cases.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026