AMERICA: Proactive Prevention Program For MSAD no Better Than Standard Care in High-Risk CAD Patients
In patients with high-risk coronary artery disease (CAD), an active strategy of detecting and treating asymptomatic multisite artery disease (MSAD) combined with intensive medical therapy did not improve two-year outcomes compared to a more traditional approach of managing only symptomatic coronary and extracoronary lesions. These findings from the AMERICA study were presented Aug. 29 at ESC Congress 2016 in Rome.
The study involved 521 CAD patients (≥75 years old) who were considered high-risk based on either recently diagnosed three-vessel disease (within the past six months) or acute coronary syndrome in the past month. Participants were randomized to either a proactive prevention program that included revascularization of asymptomatic MSAD when appropriate, life style changes and an aggressive pharmacological approach (n=263); or to a more conventional strategy based on treatment of CAD and only symptomatic extracoronary lesions (n=258).
Results showed no difference in the rate of the primary endpoint of two-year rates of all-cause mortality, rehospitalization for an ischemic event, or organ failure (44.9 percent in the prevention group and 43 percent in the conventional strategy group). Similarly, there were no significant differences in the rate of the main secondary end point – a composite of all-cause death, myocardial infarction, stroke and any revascularization (12.9 percent in the prevention group and 13.6 percent in the conventional group). Major bleeding events also occurred at a similar rate.
Although the intensive strategy identified asymptomatic MSAD in 23 percent of patients, and resulted in aggressive secondary prevention in 45.3 percent, it led to very few additional revascularization procedures (3.6 percent), and ultimately resulted in no clinical benefit over conventional management, according to lead investigator Jean-Philippe Collet, MD, PhD.
“Possible explanations for the failure of the proactive strategy were that revascularization of MSAD lesions was rare and that pharmacological treatment was close to optimal in both groups,” he adds.
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