EXPEDITED PUBLICATION: VIEWPOINT
The Truth and Consequences of the COURAGE Trial
Dean J. Kereiakes, MD, FACC*,*,
Paul S. Teirstein, MD, FACC ,
Ian J. Sarembock, MB, ChB, MD ,
David R. Holmes, Jr, MD ,
Mitchell W. Krucoff, MD, FACC¶,
William W. O’Neill, MD||,
Ron Waksman, MD, FACC#,
David O. Williams, MD**,
Jeffrey J. Popma, MD, FACC,
Maurice Buchbinder, MD, FACC,
Roxana Mehran, MD,
Ian T. Meredith, MBBS, PhD, FACC,
Jeffrey W. Moses, MD, FACC and
Gregg W. Stone, MD, FACC
* Christ Hospital Heart and Vascular Center/The Lindner Research Center, Cincinnati, Ohio
Scripps Clinic, La Jolla, California
Christ Hospital Heart and Vascular Center, Ohio Heart and Vascular Center, Cincinnati, Ohio
Mayo Clinic, Rochester, Minnesota
¶ Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina
|| University of Miami Miller School of Medicine, Miami, Florida
# Washington Hospital Center, Washington, DC
** Rhode Island Hospital, Division of Medicine, Providence, Rhode Island
Caritas Christi Health Care System/St. Elizabeth Medical Center/Tufts University School of Medicine, Boston, Massachusetts
Columbia University Medical Center, New York, New York
MonasHeart, Southern Health, Clayton, Australia.
Manuscript received May 9, 2007;
revised manuscript received June 27, 2007,
accepted July 7, 2007.
* Reprint requests and correspondence: Dr. Dean J. Kereiakes, Lindner Research Center, 2123 Auburn Avenue, Suite 424, Cincinnati, Ohio 45219. (Email: lindner{at}fuse.net).
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 ( 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.
|
Abbreviations and Acronyms
| | BMS = bare-metal stent(s) | | CCS = Canadian Cardiovascular Society | | DES = drug-eluting stent(s) | | MI = myocardial infarction | | PCI = percutaneous coronary intervention |
|
This article has been cited by other articles:
|
|
|
|
 
G. Bastarrika, Y. S. Lee, W. Huda, B. Ruzsics, P. Costello, and U. J. Schoepf
CT of Coronary Artery Disease
Radiology,
November 1, 2009;
253(2):
317 - 338.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. M. Califf
Angiographic Profiles in Courage
Circ Cardiovasc Qual Outcomes,
July 1, 2009;
2(4):
292 - 293.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G.B. J. Mancini, E. R. Bates, D. J. Maron, P. Hartigan, M. Dada, G. Gosselin, W. Kostuk, S. P. Sedlis, L. J. Shaw, D. S. Berman, et al.
Quantitative Results of Baseline Angiography and Percutaneous Coronary Intervention in the COURAGE Trial
Circ Cardiovasc Qual Outcomes,
July 1, 2009;
2(4):
320 - 327.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. C. Wijeysundera and D. T. Ko
Does Percutaneous Coronary Intervention Reduce Mortality in Patients With Stable Chronic Angina: Are We Talking About Apples and Oranges?
Circ Cardiovasc Qual Outcomes,
March 1, 2009;
2(2):
123 - 126.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. R. Holmes Jr and D. O. Williams
Catheter-Based Treatment of Coronary Artery Disease: Past, Present, and Future
Circ Cardiovasc Interv,
August 1, 2008;
1(1):
60 - 73.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Coylewright, R. S. Blumenthal, and W. Post
Placing COURAGE in Context: Review of the Recent Literature on Managing Stable Coronary Artery Disease
Mayo Clin. Proc.,
July 1, 2008;
83(7):
799 - 805.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The year in interventional cardiology.
J. Am. Coll. Cardiol.,
June 17, 2008;
51(24):
2355 - 2369.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S.-H. Choi, A. Prasad, and S. Tsimikas
The evolution of thienopyridine therapy clopidogrel duration, diabetes, and drug-eluting stents.
J. Am. Coll. Cardiol.,
June 10, 2008;
51(23):
2228 - 2229.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. F O'Rourke
How stiffening of the aorta and elastic arteries leads to compromised coronary flow
Heart,
June 1, 2008;
94(6):
690 - 691.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. L. Hannan
Randomized Clinical Trials and Observational Studies: Guidelines for Assessing Respective Strengths and Limitations
J. Am. Coll. Cardiol. Intv.,
June 1, 2008;
1(3):
211 - 217.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Sanz, P. R. Moreno, and V. Fuster
The year in atherothrombosis.
J. Am. Coll. Cardiol.,
March 4, 2008;
51(9):
944 - 955.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. K. Min, L. Hofstra, S. V. Gurudevan, and M. D. Cerqueira
Imaging highlights of the American Heart Association 2007 scientific sessions.
J. Am. Coll. Cardiol. Img.,
March 1, 2008;
1(2):
252 - 262.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, J. J. Bax, O. Ben-Yehuda, P. Clopton, G. K. Feld, G. S. Ginsburg, B. H. Greenberg, J. D. Knoke, W. Y.W. Lew, J. A.C. Lima, et al.
Highlights of the year in JACC 2007.
J. Am. Coll. Cardiol.,
January 29, 2008;
51(4):
490 - 512.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. A. Diamond and S. Kaul
COURAGE Under Fire: On the Management of Stable Coronary Disease
J. Am. Coll. Cardiol.,
October 16, 2007;
50(16):
1604 - 1609.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
