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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EPercutaneous coronary intervention (PCI) is a widely used method of restoring normal blood flow to the myocardium and is lifesaving during acute coronary events. There are little long-term clinical outcome data, however, on the benefits of PCI in patients who have stable coronary artery disease. This article discusses the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Guideline-Driven Drug Evaluation study [COURAGE; \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007; 356:1503\u20131516].\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPercutaneous coronary intervention (PCI) is a widely used method of restoring normal blood flow to the myocardium and is lifesaving during acute coronary events. There are little long-term clinical outcome data, however, on the benefits of PCI in patients who have stable coronary artery disease (CAD). William E. Boden, MD, of the Western New York Veterans Affairs Healthcare Network presented the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Guideline-Driven Drug Evaluation (COURAGE) study (\u003Cem\u003EN Engl J Med.\u003C\/em\u003E 2007; 356:1503\u20131516). The objective of this study was to determine if PCI combined with optimal medical therapy (OMT) was more beneficial than optimal medical therapy alone in patients with stable coronary artery disease. The primary endpoint was death from any cause or nonfatal myocardial infarction (MI) during a median follow-up period of 4.6 years.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe study was conducted from 1999 to 2004 at 50 sites in the United States and Canada. Patients with myocardial ischemia and significant CAD were randomly assigned to either PCI with OMT (n=1,149) or OMT alone (n=1,138). OMT was defined as the best pharmacological treatment possible including medications such as aspirin, beta-blockers, statins (target LDL-C of 60 to 85 mg\/dL), HDL-C raising therapies if required, and ACE inhibitors plus therapeutic lifestyle changes such as weight loss, improved diet, exercise, and smoking cessation. PCI was attempted in 1,007 patients; 1,006 received at least one stent. It is important to note that this study evaluated bare metal stents, as drug-coated stents were not yet available.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EDuring follow-up, no differences were observed in the primary endpoint (HR=1.05; 95% CI, 0.87 to 1.27). Results were virtually identical for the secondary endpoint death, MI, and stroke (HR=1.05; 95% CI, 0.87 to 1.27; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Additional analyses also indicated no differences in acute coronary syndrome hospitalizations (hazard ratio=1.07; 95% CI, 0.84 to 1.37) or MI (HR=1.13; 95% CI, 0.89 to 1.43). A similar number of patients required subsequent coronary artery bypass grafts (77 in the PCI group; 81 in the OMT group). Subgroup analyses did not reveal any interactions between the treatment effect and defined variables such as age, sex, or diabetes.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/21\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Survival Free of Death from Any Cause and Myocardial Infarction.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1755680958\u0022 data-figure-caption=\u0022Survival Free of Death from Any Cause and Myocardial Infarction.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/21\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/21\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/7\/1\/21\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/10990\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \u003Cp id=\u0022p-5\u0022 class=\u0022first-child\u0022\u003ESurvival Free of Death from Any Cause and Myocardial Infarction.\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-6\u0022\u003EWilliam S. Weintraub, MD, of the Christiana Healthcare System, Wilmington, Delaware gave a brief overview of the health status and economic outcomes data from the COURAGE study. Quality of life data was gathered by administering surveys including the Seattle Angina Questionnaire, the Rand 36, and the Utility by Gamble, at baseline, 1, 3, 6, and 12 months after randomization, and annually thereafter. The investigators found that angina improved in both treatment arms although the PCI group had a slight but significant incremental benefit compared to OMT. However, PCI was a more expensive choice for patients with stable CAD.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EThe authors concluded that the results of this study confirm the current American College of Cardiology\/American Heart Association clinical practice guidelines that state that PCI may be deferred in stable patients as long as OMT is initiated.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2007 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/7\/1\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmb5p\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmb5p\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}