American Journal of Cardiology
Volume 104, Issue 8 , Pages 1055-1062 , 15 October 2009

Impact of an Initial Strategy of Medical Therapy Without Percutaneous Coronary Intervention in High-Risk Patients From the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) Trial

  • David J. Maron, MD

      Affiliations

    • Vanderbilt University School of Medicine, Nashville, Tennessee
    • Corresponding Author InformationCorresponding author: Tel: (615) 400-8666; fax: (615) 936-8208
  • ,
  • John A. Spertus, MD, MPH

      Affiliations

    • Mid America Heart Institute, University of Missouri-Kansas City, Kansas City, Missouri
  • ,
  • G.B. John Mancini, MD

      Affiliations

    • University of British Columbia, Vancouver, British Columbia, Canada
  • ,
  • Pamela M. Hartigan, PhD

      Affiliations

    • Veterans Affairs Cooperative Studies Program Coordinating Center, West Haven, Connecticut
  • ,
  • Steven P. Sedlis, MD

      Affiliations

    • New York Veterans Affairs Medical Center, New York, New York
  • ,
  • Eric R. Bates, MD

      Affiliations

    • University of Michigan Medical Center, Ann Arbor, Michigan
  • ,
  • William J. Kostuk, MD

      Affiliations

    • London Health Sciences Centre, London, Ontario, Canada
  • ,
  • Marcin Dada, MD

      Affiliations

    • Hartford Hospital, Hartford, Connecticut
  • ,
  • Daniel S. Berman, MD

      Affiliations

    • Cedars-Sinai Medical Center, Los Angeles, California
  • ,
  • Leslee J. Shaw, PhD

      Affiliations

    • Emory University, Atlanta, Georgia
  • ,
  • Bernard R. Chaitman, MD

      Affiliations

    • St. Louis University, St. Louis, Missouri
  • ,
  • Koon K. Teo, MB, BCh, PhD

      Affiliations

    • McMaster University Medical Center, Hamilton, Ontario, Canada
  • ,
  • Robert A. O'Rourke, MD

      Affiliations

    • South Texas Veterans Health Care System–Audie Murphy Campus, San Antonio, Texas
  • ,
  • William S. Weintraub, MD

      Affiliations

    • Christiana Care Health System, Newark, Delaware
  • ,
  • William E. Boden, MD

      Affiliations

    • Western New York Veterans Affairs Healthcare Network and Department of Medicine, Buffalo General Hospital-State University of New York, Buffalo, New York
  • ,
  • COURAGE Trial Research Group

Received 11 April 2008 ,Revised 20 May 2008 ,Accepted 20 May 2008.

References 

  1. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356:1503–1516
  2. Weintraub WS, Spertus JA, Kolm P, Maron DJ, Zhang Z, Jurkovitz C, et al. Effect of PCI on quality of life in patients with stable coronary disease. N Engl J Med. 2008;359:677–687
  3. Boden WE, O'Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk W, et al. Design and rationale of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial Veterans Affairs Cooperative Studies Program no. 424. Am Heart J. 2006;151:1173–1179
  4. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al. ACC/AHA 2002 guideline update for the management of patients with chronic stable angina—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). J Am Coll Cardiol. 2003;41:159–168
  5. Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40:1366–1374
  6. Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Prodzinski J, McDonell M, et al. Development and evaluation of the Seattle Angina Questionnaire: a new functional status measure for coronary artery disease. J Am Coll Cardiol. 1995;25:333–341
  7. Spertus JA, Winder JA, Dewhurst TA, Deyo RA, Fihn SD. Monitoring the quality of life in patients with coronary artery disease. Am J Cardiol. 1994;74:1240–1244
  8. Spertus JA, Jones P, McDonell M, Fan V, Fihn SD. Health status predicts long-term outcome in outpatients with coronary disease. Circulation. 2002;106:43–49
  9. Zhang Z, Mahoney EM, Stables RH, Booth J, Nugara F, Spertus JA, et al. Disease-specific health status after stent-assisted percutaneous coronary intervention and coronary artery bypass surgery: one-year results from the Stent or Surgery trial. Circulation. 2003;108:1694–1700
  10. Theroux P, Fuster V. Acute coronary syndromes: unstable angina and non–Q-wave myocardial infarction. Circulation. 1998;97:1195–1206
  11. Weaver WD, Simes RJ, Betriu A, Grines CL, Zijlstra F, Garcia E, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA. 1997;278:2093–2098
  12. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361:13–20
  13. Ottervanger JP, Armstrong P, Barnathan ES, Boersma E, Cooper JS, Ohman EM, et al. Association of revascularisation with low mortality in non-ST elevation acute coronary syndrome: a report from GUSTO IV-ACS. Eur Heart J. 2004;25:1494–1501
  14. Mehta SR, Cannon CP, Fox KA, Wallentin L, Boden WE, Spacek R, et al. Routine vs selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005;293:2908–2917
  15. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, et al. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial nuclear substudy. Circulation. 2008;117:1283–1291
  16. Malenka DJ, Kaplan AV, Lucas FL, Sharp SM, Skinner JS. Outcomes following coronary stenting in the era of bare-metal vs the era of drug-eluting stents. JAMA. 2008;299:2868–2876
  17. Tu JV, Bowen J, Chiu M, Ko DT, Austin PC, He Y, et al. Effectiveness and safety of drug-eluting stents in Ontario. N Engl J Med. 2007;357:1393–1402
  18. Mauri L, Silbaugh TS, Wolf RE, Zelevinsky K, Lovett A, Zhou Z, et al. Long-term clinical outcomes after drug-eluting and bare-metal stenting in Massachusetts. Circulation. 2008;118:1817–1827
  19. Kastrati A, Mehilli J, Pache J, Kaiser C, Valgimigli M, Kelbaek H, et al. Analysis of 14 trials comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med. 2007;356:1030–1039
  20. Spaulding C, Daemen J, Boersma E, Cutlip DE, Serruys PW. A pooled analysis of data comparing sirolimus-eluting stents with bare-metal stents. N Engl J Med. 2007;356:989–997
  21. Stettler C, Wandel S, Allemann S, Kastrati A, Morice MC, Schomig A, et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet. 2007;370:937–948
  22. James SK, Stenestrand U, Lindback J, Carlsson J, Schersten F, Nilsson T, et al. Long-term safety and efficacy of drug-eluting versus bare-metal stents in Sweden. N Engl J Med. 2009;360:1933–1945

 This work was supported by the Cooperative Studies Program of the United States Department of Veterans Affairs Office of Research and Development [Veterans Affairs Cooperative Studies Program no. 424]; in collaboration with the Canadian Institutes of Health Research; and by unrestricted research grants from Merck (Whitehouse Station, New Jersey), Pfizer (New York, New York), Bristol-Myers-Squibb (New York, New York), Fujisawa (Tokyo, Japan), Kos Pharmaceuticals (Abbott Park, Illinois), Datascope (Fairfield, New Jersey), AstraZeneca (London, United Kingdom), Key Pharmaceutical (Sydney, Australia), Sanofi-Aventis (Paris, France), First Horizon (Alpharetta, Georgia), and GE Healthcare (Waukesha, Wisconsin). All industrial funding in support of the trial was directed through the United States Department of Veterans Affairs.

PII: S0002-9149(09)01179-5

doi: 10.1016/j.amjcard.2009.05.056

American Journal of Cardiology
Volume 104, Issue 8 , Pages 1055-1062 , 15 October 2009