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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

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