Percutaneous coronary intervention plus optimal medical therapy was not more effective than medical therapy alone in stable CAD

doi:10.1136/ebm.12.4.107

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Evidence-Based Medicine 2007;12:107; doi:10.1136/ebm.12.4.107
Copyright © 2007 by the BMJ Publishing Group Ltd.

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Therapeutics

Percutaneous coronary intervention plus optimal medical therapy was not more effective than medical therapy alone in stable CAD

Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503–16.[Abstract/Free Full Text]

Q In patients with stable coronary artery disease (CAD), is percutaneous coronary intervention (PCI) plus optimal medical therapy (OMT) more effective for preventing cardiovascular events than OMT alone?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ $*$ Internal medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Cardiology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$

Key Words: angioplasty (transluminal, percutaneous coronary) • coronary disease • myocardial infarction

The first 150 words of the full text of this article appear below.

METHODS
Design: randomised controlled trial (Clinical Outcomes Utilizing Revascularizationand Aggressive Drug Evaluation [COURAGE] trial).

Allocation: unclear allocation concealment.^*

Blinding: blinded (outcome adjudication committee).^*

Follow up period: median 4.6 years (range 2.5–7.0 y).

Setting: 50 centres in the US and Canada.

Patients: 2287 patients (mean age 62 y, 85% men) with stable CAD (stenosis $>=$ 70% in $>=$ 1 proximal epicardial coronary artery and objective evidenceof myocardial ischaemia, or $>=$ 1 coronary stenosis $>=$ 80% and classicangina without provocative testing). Exclusion criteria includedpersistent class IV angina, a markedly positive stress test,refractory heart failure or cardiogenic shock, ejection fraction<30%, revascularisation in $<=$ 6 months, and coronary anatomynot suitable for PCI.

Intervention: PCI (with bare metal stents in most patients) plus OMT (anti-ischaemictherapy, aggressive therapy to optimise lipid levels, and alifestyle intervention) (n = 1149) or OMT alone (n = 1138).

Outcomes: composite end point of death or non-fatal myocardial . . . [Full text of this article]

Bertram Pitt, MD

University of Michigan School of Medicine, Ann Arbor, Michigan, USA