The release of the COURAGE trial significantly increased the use of medical therapy rather than revascularization for stable angina from 11.1% to 23.0% (P=0.03).
Observational (n=332)
No
Did the release of the COURAGE trial change the management of stable angina regarding catheterization referral and revascularization?
The publication of the COURAGE trial immediately influenced clinical practice by decreasing catheterization referrals and increasing the use of medical therapy over revascularization for stable angina.
Tasa de eventos absoluta: 23% vs 11.1%
valor p: p=0.03
BACKGROUND: The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial confirmed that percutaneous coronary intervention is no better than optimal medical therapy for the prevention of major adverse cardiac events in patients with stable angina. The impact of these findings on clinical practice remains unknown. HYPOTHESIS: Clinicians may more frequently opt for medical rather than procedural therapy of stable angina in response to the COURAGE trial. METHODS: Clinical information was collected from patients with stable angina referred to our hospital for cardiac catheterization between January 1, 2007 and June 18, 2007 (n = 332). Catheterization referral volume and the use of medications and coronary revascularization were compared before and after the release of the COURAGE trial. RESULTS: There was a significant increase in anti-ischemia medication use prior to catheterization referral following the COURAGE trial (mean = 1.31 SD 0.83 medications pre-COURAGE, mean = 1.54 SD 0.84 medications post-COURAGE, P = 0.012). Among 217 patients with coronary disease on catheterization, treatment with medication rather than percutaneous or surgical revascularization increased after COURAGE (11.1% pre-COURAGE vs 23.0% post-COURAGE, P = 0.03). There was also a significant decrease in referral volume following the COURAGE trial (3.12 referrals/day pre-COURAGE vs 2.51 referrals/day post-COURAGE, P = 0.034). CONCLUSIONS: The COURAGE trial immediately impacted the management of stable angina. Catheterization referral volume decreased, medication use increased, and the use of medical therapy rather than revascularization increased among patients with coronary disease.
Atwater et al. (Wed,) conducted a observational in Stable angina (n=332). Post-COURAGE trial publication period vs. Pre-COURAGE trial publication period was evaluated on Treatment with medication rather than percutaneous or surgical revascularization among patients with coronary disease (p=0.03). The release of the COURAGE trial significantly increased the use of medical therapy rather than revascularization for stable angina from 11.1% to 23.0% (P=0.03).