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

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 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 ★★★★★★☆ Cardiology ★★★★★★☆


Embedded ImageDesign:

randomised controlled trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE] trial).

Embedded ImageAllocation:

unclear allocation concealment.*

Embedded ImageBlinding:

blinded (outcome adjudication committee).*

Embedded ImageFollow up period:

median 4.6 years (range 2.5–7.0 y).

Embedded ImageSetting:

50 centres in the US and Canada.

Embedded ImagePatients:

2287 patients (mean age 62 y, 85% men) with stable CAD (stenosis ⩾70% in ⩾1 proximal epicardial coronary artery and objective evidence of myocardial ischaemia, or ⩾1 coronary stenosis ⩾80% and classic angina without provocative testing). Exclusion criteria included persistent class IV angina, a markedly positive stress test, refractory heart failure or cardiogenic shock, ejection fraction <30%, revascularisation in ⩽6 …

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  • * See glossary.

  • For correspondence: Dr W E Boden, Buffalo General Hospital, Buffalo, NY, USA. wboden{at}

  • Sources of funding: US Department of Veterans Affairs; Canadian Institutes of Health Research; Merck; Pfizer; Bristol-Myers Squibb; Fujisawa; Kos Pharmaceuticals; Datascope; Astra-Zeneca; Key Pharmaceutical; Sanofi-Aventis; First Horizon; GE Healthcare.