Key result
Combined PCI and optimal medical therapy did not reduce the hard endpoints of death and MI compared to optimal medical therapy alone in low-risk patients with stable disease.
Why the study?
Does combined PCI and optimal medical therapy reduce death and MI or improve symptoms compared to optimal medical therapy alone in patients with chronic stable angina?
Does combined PCI and optimal medical therapy reduce death and MI or improve symptoms compared to optimal medical therapy alone in patients with chronic stable angina?
In patients with chronic stable angina, adding PCI to optimal medical therapy does not reduce the risk of death or MI, but it is highly effective for symptom relief and reducing ischemia.
Does not support routine PCI for prognostic benefit in low-risk stable CAD; confirms prior RCTs while leaving applicability to contemporary devices and higher-risk groups open.
The indications for percutaneous coronary intervention (PCI) continue to evolve because of the steady improvement in technology, broadened patient and lesion selection criteria, and new evidence from clinical trials. Recently, the role of PCI in patients with chronic stable angina has received considerable scrutiny and has been the subject of great controversy. In these patients, the goals of therapy include the relief of symptom, treatment of ischemia, and reducing the need for subsequent interventions. Medical therapy is the cornerstone in the management of coronary artery disease and should be optimized in all patients. The COURAGE trial investigated the efficacy of combined PCI and optimal medical therapy (OMT) versus OMT alone in patients with stable disease. The trial confirmed several issues that have been already well delineated: (1) in low risk patients, the hard endpoints of death and MI are relatively infrequent and are not reduced by PCI - for prevention of these, OMT may be sufficient, (2) crossover from OMT to PCI is frequent, even in low risk patients, (3) PCI is very effective in reducing symptoms and myocardial ischemia, and (4) significant untreated ischemia is associated with greater likelihood of death and MI.
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Prasad et al. (2008) conducted a review in Chronic stable angina. Combined percutaneous coronary intervention (PCI) and optimal medical therapy (OMT) vs. Optimal medical therapy (OMT) alone was evaluated on Death and myocardial infarction (MI). Combined PCI and optimal medical therapy did not reduce the hard endpoints of death and MI compared to optimal medical therapy alone in low-risk patients with stable disease.
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