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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 ★★★★★★☆
randomised controlled trial (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation [COURAGE] trial).
unclear allocation concealment.*
blinded (outcome adjudication committee).*
Follow up period:
median 4.6 years (range 2.5–7.0 y).
50 centres in the US and Canada.
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 …
↵* See glossary.
For correspondence: Dr W E Boden, Buffalo General Hospital, Buffalo, NY, USA.
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.