COURAGE TRIAL NEJM PDF

Addition of percutaneous cutaneous intervention PCI to optimal medical therapy for patients with stable coronary artery disease does not improve mortality or cardiovascular outcomes. Study Rundown: The COURAGE trial was the first to provide evidence that in patients with stable coronary artery disease, the addition of PCI to optimal medical therapy does not provide any mortality benefit or improve cardiovascular outcomes. A subsequent report from the COURAGE investigators demonstrated that patients who received PCI were free of angina and had improvements in various quality of life parameters at three months after the intervention, though this difference was not sustained at 36 months. Optimization of medical therapy alone without PCI is sufficient for initial treatment of patients with stable coronary artery disease.

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Background: In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention PCI with intensive pharmacologic therapy and lifestyle intervention optimal medical therapy is superior to optimal medical therapy alone in reducing the risk of cardiovascular events.

Methods: We conducted a randomized trial involving patients who had objective evidence of myocardial ischemia and significant coronary artery disease at 50 U. Between and , we assigned patients to undergo PCI with optimal medical therapy PCI group and to receive optimal medical therapy alone medical-therapy group. The primary outcome was death from any cause and nonfatal myocardial infarction during a follow-up period of 2.

Results: There were primary events in the PCI group and events in the medical-therapy group. The 4. There were no significant differences between the PCI group and the medical-therapy group in the composite of death, myocardial infarction, and stroke Conclusions: As an initial management strategy in patients with stable coronary artery disease, PCI did not reduce the risk of death, myocardial infarction, or other major cardiovascular events when added to optimal medical therapy.

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Comment in Does preventive PCI work? Hochman JS, et al. N Engl J Med. Epub Mar PMID: No abstract available. King SB 3rd. Nat Clin Pract Cardiovasc Med. Epub Jun Percutaneous coronary intervention plus optimal medical therapy was not more effective than medical therapy alone in stable CAD. Pitt B. ACP J Club. J Fam Pract. PCI for stable coronary disease. Katritsis DG, et al. Nagajothi N, et al. Kiat H. De Servi S. Shah AP, et al. Wharton TP Jr, et al.

Mak KH. Evid Based Med. Sosnowski C. Kardiol Pol. PMID: Polish. No abstract available. The COURAGE Trial: establishing the therapeutic legitimacy of aggressive risk factor management in patients with stable coronary artery disease as an alternative to percutaneous coronary intervention. Toth PP. Curr Atheroscler Rep. Farmer JA. Boden WE. Epub Aug Similar articles Fractional flow reserve-guided PCI versus medical therapy in stable coronary disease.

De Bruyne B, et al. Fractional flow reserve-guided PCI for stable coronary artery disease. Epub Sep 1. Xaplanteris P, et al. Epub May Percutaneous coronary intervention versus optimal medical therapy in stable coronary artery disease: a systematic review and meta-analysis of randomized clinical trials. Pursnani S, et al. Circ Cardiovasc Interv.

Epub Aug 7. PMID: Review. Percutaneous coronary intervention versus medical therapy for coronary heart disease. Maron DJ. Show more similar articles See all similar articles. Hess PL, et al. Validation of algorithms to identify elective percutaneous coronary interventions in administrative databases. Derington CG, et al. PLoS One. Figulla HR, et al. Dtsch Arztebl Int. Maron DJ, et al. Spertus JA, et al.

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BRAINSTORMS DANIEL DENNETT PDF

Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation - COURAGE

Background: In patients with stable coronary artery disease, it remains unclear whether an initial management strategy of percutaneous coronary intervention PCI with intensive pharmacologic therapy and lifestyle intervention optimal medical therapy is superior to optimal medical therapy alone in reducing the risk of cardiovascular events. Methods: We conducted a randomized trial involving patients who had objective evidence of myocardial ischemia and significant coronary artery disease at 50 U. Between and , we assigned patients to undergo PCI with optimal medical therapy PCI group and to receive optimal medical therapy alone medical-therapy group. The primary outcome was death from any cause and nonfatal myocardial infarction during a follow-up period of 2. Results: There were primary events in the PCI group and events in the medical-therapy group.

KLM EMBRYOLOGY PDF

Optimal Medical Therapy With or Without PCI for Stable Coronary Disease

In patients with stable CAD, how does optimal medical therapy plus PCI compare to optimal medical therapy alone in improving survival? OMT alone. The majority of patients in the PCI arm received bare metal stents because drug-eluting stents were not yet approved for use until the final 6 months of the study period. After a median follow-up of 4. There was also no significant difference in the rates of ACS hospitalizations between groups. Followup of the cohorts demonstrated that significantly more patients in the PCI arm were free of angina and had higher overall quality of life by 6 months, but this benefit disappeared by 36 months, likely reflecting the progression of underlying CAD. Fifteen-year follow-up data published in found no difference in mortality between the groups.

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