Percutaneous coronary intervention versus medical therapy for coronary heart disease.
Medical therapy reduces myocardial infarction and death in patients with stable coronary heart disease (CHD). In contrast, there is little evidence available to evaluate the impact of percutaneous coronary intervention (PCI) on hard endpoints in such patients. Four randomized, controlled trials have compared PCI with medical therapy. These studies have demonstrated that PCI results in an improvement in angina and exercise tolerance compared with medical therapy, but they also suggest that medical therapy may be preferable to PCI with respect to the risk of cardiac events. Interpretation of these studies has been limited by small sample size, exclusion of high-risk subjects, no or reduced use of stents, lack of a cost- effectiveness evaluation, and absence of risk factor intervention (except for Atorvastatin versus Revascularization Treatment, which used aggressive low-density lipoprotein lowering with atorvastatin in the medical group only). The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial will permit better definition of the role of PCI in the treatment of stable or recently stabilized patients with CHD.
Maron
D J
DJ
Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, 315 MRB II, Nashville, TN 37232-6300, USA. david.maron@mcmail.vanderbilt.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D000069059:Atorvastatin; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000378:metabolism; D003327:Coronary Disease / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009566:Nitrates / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000924:Anticholesteremic Agents; D002121:Calcium Channel Blockers; D008078:Cholesterol, LDL; D006538:Heptanoic Acids; D009566:Nitrates; D011758:Pyrroles; D000069059:Atorvastatin