Faculty, Staff and Student Publications
Language
English
Publication Date
9-2-2025
Journal
European Heart Journal
DOI
10.1093/eurheartj/ehaf356
PMID
40439159
PMCID
PMC12401582
PubMedCentral® Posted Date
5-29-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Background and aims: The randomized CENTURY trial tested the hypothesis that a comprehensive strategy integrating intense lifestyle modification and aggressive medical management to goals with revascularization reserved for severely reduced coronary flow capacity (CFC) by positron emission tomography (PET) would reduce risk factors, subsequent revascularization, death and myocardial infarction (MI) compared with standard of care in chronic stable coronary artery disease (CAD).
Methods: Participants were randomly assigned to standard or comprehensive care groups. Rest-stress PET quantified CFC for physiological CAD severity at baseline, 2, 5, and up to 11 years. The comprehensive care group reviewed PET results with frequent clinic visits and open 24/7 phone/email support. Standard care lacked supportive contact with blinded PET results that were unblinded only for severely reduced CFC with high mortality risk for potential revascularization.
Results: Between 2009-2017, 515 patients were assigned to comprehensive care and 513 to standard care and followed for 5 or more years. Comprehensive vs standard care decreased risk factors and summed 5-year risk score (Δ-1.1 vs + 0.33; 95% confidence interval -1.84 to -0.97; P < .0001), decreased cumulative 11-year all-cause death (4.7% vs 8.2%; P = .023), death or MI (7.0% vs 11.1%; P = .024) late revascularization (9.5% vs 14.8%; P = .021) and major adverse cardiac events (20.5% vs 29.9%; P = .0006). Only 56 of 1028 (5.4%) CENTURY patients with chronic CAD had revascularization within 90 days predominantly guided by CFC severity.
Conclusions: The randomized CENTURY trial demonstrates that comprehensive integrated lifestyle modification and medical management towards goals with revascularization reserved for severely reduced CFC, significantly reduced risk factor scores, death, death or MI, and revascularization.
Keywords
Humans, Coronary Artery Disease, Male, Female, Myocardial Revascularization, Middle Aged, Aged, Positron-Emission Tomography, Chronic Disease, Coronary Circulation, Myocardial Infarction, Risk Factors, Chronic stable coronary syndromes, Positron emission tomography, Coronary flow reserve, Coronary flow capacity, Lifestyle modification, Optimal medical therapy, Coronary revascularization
Published Open-Access
yes
Recommended Citation
Gould, K Lance; Johnson, Nils P; Roby, Amanda E; et al., "Optimal Medical Care and Coronary Flow Capacity-Guided Myocardial Revascularization vs Usual Care for Chronic Coronary Artery Disease: The Century Trial" (2025). Faculty, Staff and Student Publications. 1190.
https://digitalcommons.library.tmc.edu/uthsph_docs/1190
Graphical Abstract
Comments
This article has been corrected. See Eur Heart J. 2025 Jun 23;46(33):3286.
Clinicaltrials.gov: NCT00756379.