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J Am Coll Cardiol, 2007; 50:1604-1609, doi:10.1016/j.jacc.2007.08.010 (Published online 14 September 2007).
© 2007 by the American College of Cardiology Foundation
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EXPEDITED PUBLICATION: COMMENTARY

COURAGE Under Fire

On the Management of Stable Coronary Disease

George A. Diamond, MD, FACC* and Sanjay Kaul, MD, FACC

Division of Cardiology, Cedars-Sinai Medical Center, and the David Geffen School of Medicine, University of California, Los Angeles, California.

Manuscript received August 9, 2007; revised manuscript received August 17, 2007, accepted August 27, 2007.

* Reprint requests and correspondence: Dr. George A. Diamond, 2408 Wild Oak Drive, Los Angeles, California 90068. (Email: gadiamond{at}pol.net).

The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial showed that coronary interventional procedures added little to optimal medical therapy with respect to the long-term outcome of patients with stable coronary disease when used as initial therapy. Detractors opine that: 1) the trial was unrealistic in design and the findings were not unexpected; 2) the use of coronary interventional procedures was suboptimal; and 3) the results of COURAGE are not applicable to current clinical practice. We herein reevaluate the evidence with regard to each of these points, and conclude that COURAGE indeed provides relevant new information to assist the practitioner in the appropriate management of patients with stable coronary disease

Abbreviations and Acronyms
  DES = drug-eluting stent(s)
  MI = myocardial infarction
  NYHA = New York Heart Association
  OMT = optimal medical therapy
  PCI = percutaneous coronary intervention




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Copyright © 2007 by the American College of Cardiology Foundation.