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EXPEDITED PUBLICATION: COMMENTARY

COURAGE Under Fire

On the Management of Stable Coronary Disease

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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