Abstract
Early coronary revascularization has been shown to reduce major adverse cardiovascular
events in patients with acute coronary syndromes. In patients with stable coronary
heart disease (CHD), however, coronary revascularization does not reduce death or
myocardial infarction compared to intensive medical therapy. The Clinical Outcomes
Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial was the
first to study whether coronary revascularization performed in addition to medical
therapy, rather than as an alternative, would reduce death or myocardial infarction
in patients with stable CHD. Between 1999 and 2004, 2287 patients were enrolled in
50 centers throughout Canada and the United States. After a median follow-up of 4.6
years, revascularization performed in addition to intensive medical therapy did not
result in reduced mortality or myocardial infarction compared to medical therapy alone.
At the end of follow-up, anginal control was similar in both groups, although patients
receiving medical therapy only did require more antianginal medications, and one-third
ultimately required revascularization. We review the strengths, limitations, and clinical
relevance of the COURAGE trial in the context of the current literature on the benefits
of medical management and coronary revascularization in patients with stable CHD.
Keywords
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Article info
Publication history
Published online: October 22, 2007
Accepted:
October 15,
2007
Received:
October 9,
2007
Identification
Copyright
© 2007 National Lipid Association. Published by Elsevier Inc. All rights reserved.
