Open AccessThe Immediate Impact of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) Trial on the Management of Stable Angina
Author(s) -
Atwater Brett D.,
Oujiri James,
Wolff Matthew R.
Publication year - 2009
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20524
Subject(s) - medicine , courage , revascularization , angina , clinical trial , drug , intensive care medicine , stable angina , cardiology , coronary heart disease , pharmacology , myocardial infarction , philosophy , theology
Background The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial confirmed that percutaneous coronary intervention is no better than optimal medical therapy for the prevention of major adverse cardiac events in patients with stable angina. The impact of these findings on clinical practice remains unknown. Hypothesis Clinicians may more frequently opt for medical rather than procedural therapy of stable angina in response to the COURAGE trial. Methods Clinical information was collected from patients with stable angina referred to our hospital for cardiac catheterization between January 1, 2007 and June 18, 2007 (n = 332). Catheterization referral volume and the use of medications and coronary revascularization were compared before and after the release of the COURAGE trial. Results There was a significant increase in anti‐ischemia medication use prior to catheterization referral following the COURAGE trial (mean = 1.31 [SD 0.83] medications pre‐COURAGE, mean = 1.54 [SD 0.84] medications post‐COURAGE, P = 0.012). Among 217 patients with coronary disease on catheterization, treatment with medication rather than percutaneous or surgical revascularization increased after COURAGE (11.1% pre‐COURAGE vs 23.0% post‐COURAGE, P = 0.03). There was also a significant decrease in referral volume following the COURAGE trial (3.12 referrals/day pre‐COURAGE vs 2.51 referrals/day post‐COURAGE, P = 0.034). Conclusions The COURAGE trial immediately impacted the management of stable angina. Catheterization referral volume decreased, medication use increased, and the use of medical therapy rather than revascularization increased among patients with coronary disease. Copyright © 2009 Wiley Periodicals, Inc.