March 30, 2007 (New Orleans, Louisiana) — Percutaneous coronary intervention (PCI) plus stenting and optimal medical therapy is no better at preventing future events than optimal medical therapy alone in patients with stable coronary artery disease (CAD), according to the results of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial. The much-anticipated results, presented here during a late-breaking clinical-trials session by lead investigator William E. Boden, MD, from the Buffalo General Hospital in Buffalo, NY, add fuel to the mounting fire about whether stents, including drug-eluting stents, are being overused for the treatment of stable CAD or for the prevention of future cardiac events.
Full results of the study were published simultaneously online in the March 27 Early Release issue of The New England Journal of Medicine.
"Although the addition of PCI to optimal medical therapy reduced the prevalence of angina, it did not reduce long-term rates of death, nonfatal myocardial infarction, and hospitalization for acute coronary syndromes," Dr. Boden and colleagues conclude in the article.
In an editorial accompanying the study, Judith S. Hochman, MD, from the New York University School of Medicine in New York, and P. Gabriel Steg, MD, from the Université Paris in Paris, France, say the study findings are practice changing.
"The COURAGE trial should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial healthcare savings," the editorialists write. "PCI has an established place in treating angina, but is not superior to intensive medical therapy to prevent myocardial infarction and death in symptomatic or asymptomatic patients such as those in this study."
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