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JCOM Abstract

J Clin Outcomes Manage 
2008 Jul;15(7):344-352
Coronary revascularization in patients with stable or asymptomatic coronary artery disease: a review of the COURAGE trial
Reed MC, Gurm HS

Abstract Objective: To review the COURAGE trial and other data related to revascularization of patients with asymptomatic or stable coronary artery disease. Methods: Literature review. Results: The goals of therapy in patients with stable angina are to alleviate symptoms, prevent future events, and improve survival. This is achieved by a combination of antiplatelet therapy, risk factor modification, antianginal medications, and revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting. The COURAGE trial compared optimal medical therapy plus PCI with bare-metal stenting with optimal medical therapy alone. No significant difference was seen in the rate of death or MI; patients in the PCI group had less angina and 1 and 3 years but not at 5 years and had fewer new revascularizations. Conclusion: Revascularization in asymptomatic or stable CAD is reasonable in patients who continue to have symptoms despite optimal medical therapy and in patients in whom revascularization may change survival. Patient preferences should be included in decision making.

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