Key result
Percutaneous coronary intervention added to optimal medical therapy did not reduce the risk of death or nonfatal myocardial infarction compared with optimal medical therapy alone in patients with stable coronary artery disease (HR 1.05).
Why the study?
Does percutaneous coronary intervention coupled with optimal medical therapy reduce all-cause mortality or nonfatal MI in patients with stable coronary artery disease compared with optimal medical therapy alone?
Does percutaneous coronary intervention coupled with optimal medical therapy reduce all-cause mortality or nonfatal MI in patients with stable coronary artery disease compared with optimal medical therapy alone?
Effect estimate: HR 1.05 (95% CI 0.87-1.27)
Absolute Event Rate: 19% vs 18.5%
p-value: p=0.62
In patients with stable coronary artery disease, an initial strategy of PCI added to optimal medical therapy did not reduce the risk of death or myocardial infarction compared to optimal medical therapy alone, though it provided greater initial angina relief.
Supports OMT-first approach for event reduction in stable CAD; confirms prior randomized findings in updated synthesis.
The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial was designed to determine whether percutaneous coronary intervention (PCI) coupled with optimal medical therapy (OMT) reduced the risk of death or nonfatal myocardial infarction in patients with stable coronary artery disease as compared with OMT alone. COURAGE demonstrated that an initial strategy of PCI added to OMT in these patients relieved angina to a greater extent than an initial strategy of OMT alone for a period of approximately 24 months. The initial strategy of PCI (plus OMT) did not reduce death, myocardial infarction, or other major cardiovascular events compared with OMT alone. The important quality-of-life findings permit physicians to engage in an evidence-based discussion with patients about the expected clinical and health status benefits of initial versus deferred PCI when added to OMT.
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William E. Boden (2009) conducted a review in Stable coronary artery disease (n=2,287). Percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) vs. Optimal medical therapy (OMT) alone was evaluated on All-cause mortality or nonfatal myocardial infarction (HR 1.05, 95% CI 0.87-1.27, p=0.62). Percutaneous coronary intervention added to optimal medical therapy did not reduce the risk of death or nonfatal myocardial infarction compared with optimal medical therapy alone in patients with stable coronary artery disease (HR 1.05).
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