Mean Follow-Up: Median, 4. Anti-ischemic therapy included long-acting metoprolol, amlodipine, and isosorbide mononitrate, alone or in combination, and either lisinopril or losartan as secondary prevention. One-third of patients had proximal disease of the left anterior descending artery. Diet, exercise, and smoking cessation were also high in both groups. The primary endpoint of death or MI did not differ for the PCI group compared with the medical therapy group Findings were similar during extended follow-up to 15 years.
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Print Image: PD 1. Addition of percutaneous cutaneous intervention PCI to optimal medical therapy for patients with stable coronary artery disease does not improve mortality or cardiovascular outcomes Study Rundown: The COURAGE trial was the first to provide evidence that in patients with stable coronary artery disease, the addition of PCI to optimal medical therapy does not provide any mortality benefit or improve cardiovascular outcomes.
A subsequent report from the COURAGE investigators demonstrated that patients who received PCI were free of angina and had improvements in various quality of life parameters at three months after the intervention, though this difference was not sustained at 36 months.
Optimization of medical therapy alone without PCI is sufficient for initial treatment of patients with stable coronary artery disease. The addition of PCI to optimal medical therapy does not improve mortality or cardiovascular outcomes as evidenced by the COURAGE trial, and given its risks as an invasive procedure, should not be offered as initial treatment strategy for this patient population.
Patients were randomized to two groups: 1 optimal medical therapy alone, or 2 optimal medical therapy with PCI. All patients were optimized medically on an angiotensin-converting-enzyme inhibitor ACE-I or angiotensin receptor blocker ARB , antiplatelet therapy acetylsalicylic acid or clopidogrel , as well as a combination of beta-blockers, calcium channel blockers and nitrates.
All patients also received aggressive lipid optimizing therapy. The primary outcome studied was a composite of death from any cause and non-fatal myocardial infarction. The medium follow-up period was 4. There was no significant difference in the primary outcome between the two groups. Furthermore, rates of hospitalization for ACS were not significantly different between the two groups.
The need for subsequent revascularization procedures PCI or coronary artery bypass graft was, however, significantly higher in the medical therapy group as compared to the PCI group By Aimee Li, M.
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Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation - COURAGE
Banris What I find surprising is the surprised reaction of many commentators. N Engl J Med Mar 27; [pub ahead of print]. 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 Journal of Medicine. Half of tgial patients undergoing urgent revascularization had no objective evidence of ischemia i. Optimal medical therapy with or without PCI for stable coronary disease. Women also had higher LVEF, fewer diseased coronary vessels, and higher baseline HDL but worse kidney function and a slightly longer duration of angina. Compared with men enrolled in COURAGE, women were older 64 vs 62 years oldmore likely to be white and to have a family history of CAD, and less likely to have had prior revascularization.
COURAGE TRIAL NEJM PDF