***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT Many patients with chronic angina experience anginal episodes despite revascularization and antianginal medications . In a previous trial , antianginal monotherapy with ranolazine , a drug believed to partially inhibit fatty acid oxidation , increased treadmill exercise performance ; however , its long-term efficacy and safety have not been studied in combination with beta-blockers or calcium antagonists in a large patient population with severe chronic angina . OBJECTIVES To determine whether , at trough levels , ranolazine improves the total exercise time of patients who have symptoms of chronic angina and who experience angina and ischemia at low workloads despite taking st and ard doses of atenolol , amlodipine , or diltiazem  and to determine times to angina onset and to electrocardiographic evidence of myocardial ischemia , effect on angina attacks and nitroglycerin use , and effect on long-term survival in an open-label observational study extension . DESIGN , SETTING , AND PATIENTS A r and omized , 3-group parallel , double-blind , placebo-controlled trial of 823 eligible adults with symptomatic chronic angina who were r and omly assigned to receive placebo or 1 of 2 doses of ranolazine . Patients treated at the 118 participating ambulatory outpatient setting s in several countries were enrolled in the Combination Assessment of Ranolazine In Stable Angina ( CARISA ) trial from July 1999 to August 2001 and followed up through October 31 , 2002 . INTERVENTION Patients received twice-daily placebo or 750 mg or 1000 mg of ranolazine . Treadmill exercise 12 hours ( trough ) and 4 hours ( peak ) after dosing was assessed after 2 , 6 ( trough only ) , and 12 weeks of treatment . MAIN OUTCOME MEASURES Change in exercise duration , time to onset of angina , time to onset of ischemia , nitroglycerin use , and number of angina attacks . RESULTS Trough exercise duration increased by 115.6 seconds from baseline in both ranolazine groups ( pooled ) vs 91.7 seconds in the placebo group ( P = .01 ) . The times to angina and to electrocardiographic ischemia also increased in the ranolazine groups , at peak more than at trough . The increases did not depend on changes in blood pressure , heart rate , or background antianginal therapy and persisted throughout 12 weeks . Ranolazine reduced angina attacks and nitroglycerin use by about 1 per week vs placebo ( P<.02 ) . Survival of 750 patients taking ranolazine  during the CARISA trial or its associated long-term open-label study was 98.4 % in the first year and 95.9 % in the second year . CONCLUSION Twice-daily doses of ranolazine increased exercise capacity and provided additional antianginal relief to symptomatic patients with severe chronic angina taking st and ard doses of atenolol , amlodipine , or diltiazem , without evident adverse , long-term survival consequences over 1 to 2 years of therapy BACKGROUND Optimal treatment for patients with both type 2 diabetes mellitus and stable ischemic heart disease has not been established . METHODS We r and omly assigned 2368 patients with both type 2 diabetes and heart disease to undergo either prompt revascularization with intensive medical therapy or intensive medical therapy alone and to undergo either insulin-sensitization or insulin-provision therapy . Primary end points were the rate of death and a composite of death , myocardial infa rct ion , or stroke ( major cardiovascular events ) . R and omization was stratified according to the choice of percutaneous coronary intervention ( PCI ) or coronary-artery bypass grafting ( CABG ) as the more appropriate intervention . RESULTS At 5 years , rates of survival did not differ significantly between the revascularization group ( 88.3 % ) and the medical-therapy group ( 87.8 % , P=0.97 ) or between the insulin-sensitization group ( 88.2 % ) and the insulin-provision group ( 87.9 % , P=0.89 ) . The rates of freedom from major cardiovascular events also did not differ significantly among the groups : 77.2 % in the revascularization group and 75.9 % in the medical-treatment group ( P=0.70 ) and 77.7 % in the insulin-sensitization group and 75.4 % in the insulin-provision group ( P=0.13 ) . In the PCI stratum , there was no significant difference in primary end points between the revascularization group and the medical-therapy group . In the CABG stratum , the rate of major cardiovascular events was significantly lower in the revascularization group ( 22.4 % ) than in the medical-therapy group ( 30.5 % , P=0.01 ; P=0.002 for interaction between stratum and study group ) . Adverse events and serious adverse events were generally similar among the groups , although severe hypoglycemia was more frequent in the insulin-provision group ( 9.2 % ) than in the insulin-sensitization group ( 5.9 % , P=0.003 ) . CONCLUSIONS Overall , there was no significant difference in the rates of death and major cardiovascular events between patients undergoing prompt revascularization and those undergoing medical therapy or between strategies of insulin sensitization and insulin provision . ( Clinical Trials.gov number , NCT00006305 . OBJECTIVES This study sought to determine whether initial medical therapy ( MT ) only or percutaneous coronary intervention plus medical therapy ( PCI+MT ) is better for patients with low-risk stable coronary artery disease ( CAD ) indicated for intervention in Japan . BACKGROUND Several multicenter studies have suggested that in the above patients , an initial management strategy of PCI+MT does not reduce the long-term risk of cardiovascular events more effectively than initial MT only . METHODS We conducted a r and omized comparative study ( JSAP [ Japanese Stable Angina Pectoris ] study ) in the previously mentioned patients . RESULTS The patients were r and omized to PCI+MT ( n = 192 ) or initial MT only group ( n = 192 ) , and the patient characteristics were very similar in the 2 groups . During the 3.3-year follow-up , there was no significant difference in the cumulative death rate  between PCI+MT ( 2.9 % ) and MT ( 3.9 % ) . However , the cumulative risk of death plus acute coronary syndrome was significantly smaller in PCI+MT . CONCLUSIONS In stable low-risk CAD , PCI+MT may improve long-term prognosis more effectively than MT OBJECTIVE We sought to conduct a r and omized trial comparing late revascularization with conservative therapy in symptom-free patients after acute myocardial infa rct ion ( AMI ) . BACKGROUND In the absence of ischemia , the benefits of reperfusion late after AMI remain controversial . However , the possibility exists that an open infa rct related artery benefits healing post AMI . METHODS Of 223 patients enrolled with Q-wave anterior AMI , 66 with isolated persistent occlusion of the left anterior descending coronary artery ( LAD ) were r and omized to the following treatments : 1 ) medical therapy ( closed artery group ; n = 34 ) or 2 ) late intervention and stent to the LAD + medical therapy ( open artery group ; n = 32 ) . The study was powered to compare left ventricular ( LV ) end-systolic volume between the two groups 12 months post AMI . RESULTS Late intervention 26 + /- 18 days post AMI result ed in significantly greater LV end-systolic and end-diastolic volumes at 12 months than medical therapy alone ( 106.6 + /- 37.5 ml vs. 79.7 + /- 34.4 ml , p < 0.01 and 162.0 + /- 51.4 ml vs. 130.1 + /- 46.1 ml , p < 0.01 , respectively ) . Exercise duration and peak workload significantly increased in both groups from 6 weeks to 12 months post AMI , although absolute values were greater in the open artery group . Quality of life scores tended to deteriorate during this time interval in the closed artery patients but remained unchanged in the open artery patients . Coronary angiography at 1 year documented a low incidence of intergroup cross-over ( spontaneous recanalization in 19 % and closure in 11 % ) . CONCLUSIONS In the present study , recanalization of occluded infa rct -related arteries in symptom-free patients approximately 1 month post AMI had an adverse effect on remodeling but tended to increase exercise tolerance and improve quality of life Background — Extent and severity of myocardial ischemia are determinants of risk for patients with coronary artery disease , and ischemia reduction is an important therapeutic goal . The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation ( COURAGE ) nuclear sub study compared the effectiveness of percutaneous coronary intervention ( PCI ) for ischemia reduction added to optimal medical therapy ( OMT ) with the use of myocardial perfusion single photon emission computed tomography ( MPS ) . Methods and Results — Of the 2287 COURAGE patients , 314 were enrolled in this sub study of serial rest/stress MPS performed before treatment and 6 to 18 months ( mean=374±50 days ) after r and omization using paired exercise ( n=84 ) or vasodilator stress ( n=230 ) . A blinded core laboratory analyzed quantitative MPS measures of percent ischemic myocardium . Moderate to severe ischemia encumbered ≥10 % myocardium . The primary end point was ≥5 % reduction in ischemic myocardium at follow-up . Treatment groups had similar baseline characteristics . At follow-up , the reduction in ischemic myocardium was greater with PCI+OMT ( −2.7 % ; 95 % confidence interval , −1.7 % , −3.8 % ) than with OMT ( −0.5 % ; 95 % confidence interval , −1.6 % , 0.6 % ; P<0.0001 ) . More PCI+OMT patients exhibited significant ischemia reduction ( 33 % versus 19 % ; P=0.0004 ) , especially patients with moderate to severe pretreatment ischemia ( 78 % versus 52 % ; P=0.007 ) . Patients with ischemia reduction had lower unadjusted risk for death or myocardial infa rct ion ( P=0.037 [ risk-adjusted P=0.26 ] ) , particularly if baseline ischemia was moderate to severe ( P=0.001 [ risk-adjusted P=0.08 ] ) . Death or myocardial infa rct ion rates ranged from 0 % to 39 % for patients with no residual ischemia to ≥10 % residual ischemia on follow-up MPS ( P=0.002 [ risk-adjusted P=0.09 ] ) . Conclusions — In COURAGE patients who underwent serial MPS , adding PCI to OMT result ed in greater reduction in ischemia compared with OMT alone . Our findings suggest a treatment target of ≥5 % ischemia reduction with OMT with or without coronary revascularization BACKGROUND It has not been clearly established whether percutaneous coronary intervention ( PCI ) can provide an incremental benefit in quality of life over that provided by optimal medical therapy among patients with chronic coronary artery disease . METHODS We r and omly assigned 2287 patients with stable coronary disease to  PCI plus optimal medical therapy or to optimal medical therapy alone . We assessed angina-specific health status ( with the use of the Seattle Angina Question naire ) and overall physical and mental function ( with the use of the R AND 36-item health survey [ R AND -36 ] ) . RESULTS At baseline , 22 % of the patients were free of angina . At 3 months , 53 % of the patients in the PCI group and 42 % in the medical-therapy group were angina-free ( P<0.001 ) . Baseline mean ( + /-SD ) Seattle Angina Question naire scores ( which range from 0 to 100 , with higher scores indicating better health status ) were 66+/-25 for physical limitations , 54+/-32 for angina stability , 69+/-26 for angina frequency , 87+/-16 for treatment satisfaction , and 51+/-25 for quality of life . By 3 months , these scores had increased in the PCI group , as compared with the medical-therapy group , to 76+/-24 versus 72+/-23 for physical limitation ( P=0.004 ) , 77+/-28 versus 73+/-27 for angina stability ( P=0.002 ) , 85+/-22 versus 80+/-23 for angina frequency ( P<0.001 ) , 92+/-12 versus 90+/-14 for treatment satisfaction ( P<0.001 ) , and 73+/-22 versus 68+/-23 for quality of life ( P<0.001 ) . In general , patients had an incremental benefit from PCI for 6 to 24 months ; patients with more severe angina had a greater benefit from PCI . Similar incremental benefits from PCI were seen in some but not all R AND -36 domains . By 36 months , there was no significant difference in health status between the treatment groups . CONCL 
    Output:
    
Initial stent implantation for stable CAD shows no evidence of benefit compared with initial medical therapy for prevention of death , nonfatal MI , unplanned revascularization , or angina