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Comprehensive care significantly reduces all-cause death from 8.2% to 4.7% in coronary artery diseaseComprehensive heart care reduces death and major cardiac events

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Key Takeaway
Consider integrated lifestyle modification and medical treatment to reduce all-cause death and MACE in coronary artery disease.

This randomized controlled trial enrolled 1028 participants with high risk factors for suspected or known coronary artery disease (CAD). Participants were assigned to either comprehensive care or standard care. Comprehensive care included integrated lifestyle modification, medical treatment, and revascularization reserved only for severely reduced coronary flow capacity (CFC) as determined by PET, supported by frequent clinic visits and 24/7 communication.

Standard care consisted of cardiologist-directed community care without supportive contact and with blinded PET results, except for those with severely reduced CFC. At the 5-year follow-up, the comprehensive care group showed significantly lower all-cause death (4.7% vs. 8.2%, P = 0.023) and fewer deaths or myocardial infarctions (7.0% vs. 11.1%, P = 0.024). Additionally, major adverse cardiac events were lower in the comprehensive group (20.5% vs. 29.9%, P = 0.0006), and late revascularization was reduced (9.6% vs. 14.8%, P = 0.011).

Safety data regarding adverse events or tolerability were not reported. A limitation of the study is that follow-up for the period between 5 to 11 years was not pre-defined. These findings suggest that an integrated approach involving lifestyle modification and specific revascularization criteria may improve outcomes in CAD patients.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in managing coronary artery disease by demonstrating the efficacy of a comprehensive care model including lifestyle modifications. While previous coverage noted that digital health programs like SK-121 improved knowledge and adherence, this study provides evidence for integrated clinical and lifestyle interventions reducing mortality and MACE in CAD patients.

Living with coronary artery disease often feels like a constant balancing act between managing symptoms and preventing serious complications. A large study involving over 1,000 people looked at how a more hands-on approach could change the outlook for patients with high risk factors.

The study compared standard care to a comprehensive program. This intensive plan included integrated lifestyle changes, medical treatment, and constant support through clinic visits and around-the-clock phone or email access. They only used procedures like stenting or bypass surgery when imaging showed severely reduced blood flow.

After five years, the results were clear. Patients in the comprehensive care group had lower rates of all-cause death and fewer heart attacks compared to those receiving standard care. The program also led to fewer major adverse cardiac events and a lower need for later surgeries. While some data on long-term follow-up was not pre-planned, the five-year results show that adding consistent support and lifestyle changes can make a real difference.

What this means for you:
Comprehensive care including lifestyle changes and constant support reduces death and heart attacks in heart patients.

Common questions

What is the difference between standard care and comprehensive care?

Standard care involves typical cardiologist-directed community care. Comprehensive care adds integrated lifestyle changes, frequent clinic visits, and 24/7 phone or email support. In both groups, procedures to open blocked arteries were only used if imaging showed severely reduced blood flow.

How did the comprehensive program affect heart health outcomes?

At the five-year mark, patients in the comprehensive group had a 4.7% death rate compared to 8.2% in the standard group. They also saw fewer major adverse cardiac events (20.5% vs. 29.9%) and fewer heart attacks or deaths (7.0% vs. 11.1%).

Did the comprehensive care reduce the need for later surgeries?

Yes, the study found that patients receiving comprehensive care had a lower rate of late revascularization, which are procedures to open blocked arteries. The rate was 9.6% in the comprehensive group compared to 14.8% in the standard care group.

Study Details

Study typeRct
EvidenceLevel 2
Follow-up60.0 mo
PublishedAug 2026
View Original Abstract ↓
BACKGROUND AND AIMS: Randomized trials in chronic coronary artery disease (CAD) tested single interventions of lifestyle, medical treatment, or revascularization. The randomized CENTURY trial tested a comprehensive strategy integrating intense lifestyle modification, medical treatment and revascularization reserved for severely reduced coronary flow capacity (CFC) by positron emission tomography (PET), for reducing death, myocardial infarction and revascularization compared with referring-cardiologist-directed standard community care. METHODS: Participants with high risk factors, suspected or known CAD were randomly assigned to comprehensive or standard care. Rest-stress PET quantified CFC for physiological CAD severity at baseline, 2 and 5 years. 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, unblinded for severely reduced CFC with high mortality risk for potential revascularization. RESULTS: Of 1028 randomized participants, 515 were assigned to comprehensive care and 513 to standard care for the 5-year protocol with additional follow-up over next 5 to 11 years. Comprehensive vs standard care significantly decreased 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). Only 56 of 1028 (5.4%) CENTURY patients had revascularization within 90 days guided by CFC severity, thereby reassuring and motivating patients and physicians for safely pursuing preventive risk factor goals while reserving angiogram-revascularization for high-risk, severe CFC. Intensity of adherence to comprehensive risk factor control during 5-years associated with additional significantly reduced death, MI and revascularizations over next 5 to 11 years. CONCLUSIONS: The randomised CENTURY trial demonstrates that comprehensive integrated lifestyle modification and optimal medical treatment with revascularization reserved for severely reduced CFC significantly reduced death, death or MI, and revascularization at 5 years and potentially over extended 5 to 11 years of non-predefined follow-up. (ClinicalTrials.gov NCT00756379).
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