It has not been clearly established whether percutaneous coronary intervention ( PCI) can provide an incremental benefit in quality of life over that provided by. tee and the members of the COURAGE. Trial Executive Committee are provided in the Supplementary Appendix, avail- able at was evaluated in the Fractional Flow Reserve versus Angiography for Multivessel Evaluation (FAME) trial, in which patients were randomly.

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The results of one of the more remarkable studies from the meeting of the American College of Cardiology were presented on Monday, along with the simultaneous early publishing of the study online in the New England Journal of Medicine.

The COURAGE Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial was a randomized trial involving patients with stable but significant coronary artery disease who were randomized to either undergo PCI using bare metal stents or to receive optimal medical therapy alone. The primary outcome of the study was a composite outcome of death from any cause and non-fatal myocardial infarction.

During a mean follow up of 4.

COURAGE – Wiki Journal Club

Secondary endpoints included hospitalization for acute coronary syndrome, stroke, rates of MI and death. All secondary outcomes and individual components of the primary outcomes showed no significant differences between the study groups. Although there was trlal statistically significant difference in the rate of patients who were free from angina between the study groups at 1 and 3 years, this difference was not significant at baseline or at 5 years of follow-up.


Two thirds of the patients had multi-vessel disease.

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courabe Both of the study groups received optimization of medical therapy, including aspirin along with aggressive lipid and blood pressure lowering. The results from the study are surprising and somewhat unexpected. The authors of the study explain their results, in part, by the physiologic differences between vulnerable plaques which rupture and are associated with acute coronary courgae and more fibrous plaques that can cause luminal narrowing and anginal symptoms in patients with stable disease such as those in enrolled in this study.

In summary, this study reveals that PCI offers no benefit over aggressive medical management when performed in patients with stable coronary artery disease, and suggests that PCI may be deferred in patients with stable disease as long as medical therapy is optimized trlal maintained. Boden WE et al. Optimal medical therapy with or without PCI for stable coronary disease.

COURAGE Substudy: PCI Adds No Overall Benefit to OMT Alone in Either Women or Men |

N Engl J Med Mar 27; [pub ahead of print]. What I find surprising is the surprised reaction of many commentators.


This study is consistent with everything we know about chronic stable coronary heart disease, i. I hope this study will raises public awareness of the routine overuse of revascularization as a primary treatment modality for coronary heart disease.

Revascularization at the drop of the hat became the in thing for interventional cardiologists, without taking into consideration the importance of collateral couurage, degree of coronary reserve and the risk of reperfusion injury.

You need to document perfusion defect with Myocardial Perfusion Imaging Stress Thallium as popularly known and of course take into account the clinical evaluation of the individual patient.

Chronic CAD patients usually develop collaterals and aggressive revascularization may risk reperfusion injury of the trixl already adjusted to lower oxygen load.

Also, survival advantage has been demonstrated for revascularization, and particularly with CABG for important patient subgroups—this is based mainly on anatomic features, despite stable symptomatology. Breaking News Cardiology Journal Club. Commentary by Cara Litvin, PGY-3 The results of one of the more remarkable studies from the meeting of the American College of Cardiology were presented on Monday, along with the simultaneous early publishing of the study online in the New England Nejj of Medicine.