The truth and consequences of the COURAGE trial.
Percutaneous coronary intervention (PCI) has played an integral role in the therapeutic management strategies for patients who present with either acute coronary syndromes or stable angina pectoris. The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial enrolled patients with chronic stable angina and at least 1 significant (> or =70%) angiographic coronary stenosis who were randomly assigned to an initial treatment of either PCI in conjunction with optimal medical therapy or optimal medical therapy alone. Although the initial management strategy of PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events, improvement in angina-free status and a reduction in the requirement for subsequent revascularization was observed. An in-depth analysis of the COURAGE trial design and execution is provided.
Kereiakes
Dean J
DJ
Christ Hospital Heart and Vascular Center/The Lindner Research Center, Cincinnati, Ohio 45219, USA. lindner@fuse.net
Teirstein
Paul S
PS
Sarembock
Ian J
IJ
Holmes
David R
DR
Krucoff
Mitchell W
MW
O'Neill
William W
WW
Waksman
Ron
R
Williams
David O
DO
Popma
Jeffrey J
JJ
Buchbinder
Maurice
M
Mehran
Roxana
R
Meredith
Ian T
IT
Moses
Jeffrey W
JW
Stone
Gregg W
GW
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000789:Angina, Unstable / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000628:therapy*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D017202:Myocardial Ischemia / Q000628:therapy; D010349:Patient Compliance; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin