Medical treatment matches coronary intervention
Simon Fraser/Science Photo Library
PCI is used to treat arterial stenosis |
Optimal medical therapy is as effective as percutaneous coronary intervention (PCI) in reducing the risk of death, myocardial infarction and other major cardiovascular events in patients with stable coronary artery disease, according to a prospective study that is predicted to change practice (New England Journal of Medicine 2007;356:1503).
The COURAGE trial randomised over 2,000 patients with objective evidence
of myocardial ischaemia and significant coronary artery disease to PCI
or optimal medical therapy. There was no difference in the death rates
from any cause and non-fatal myocardial infarction at median follow-up
of 4.6 years (19 per cent versus 18.5 per cent; hazard ratio for the
PCI group, 1.05; 95 per cent confidence interval 0.87 to 1.27; P=0.62).
The findings will change practice, suggested William Boden, professor
of medicine and public health, University of Buffalo School of Medicine,
New York, and lead author of the trial. “As an initial management
approach, optimal medical therapy without routine PCI can be implemented
safely in the majority of patients with stable coronary artery disease.”
He added: “Secondary prevention has proved its worth, with lipid-modulating
therapy, lifestyle modification and the use of aspirin, beta-blockers
and ACE inhibitors.”
David Taggart, professor of cardiovascular surgery, University of Oxford,
agreed. “This is a very important trial. The results reinforce
what some of us have believed for some time — that there is an
overuse of PCI in some patients with stable coronary artery disease.”
He suggested that the findings illustrated the need for a multidisciplinary
approach offering treatment that is in the best interests of the patient,
rather than individual cardiologists making decisions in isolation. |
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