Medical College of Wisconsin
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The immediate impact of the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial on the management of stable angina. Clin Cardiol 2009 Aug;32(8):E1-3



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2-s2.0-69249109708   11 Citations


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.

Author List

Atwater BD, Oujiri J, Wolff MR


James Oujiri MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Academic Medical Centers
Angina Pectoris
Angioplasty, Balloon, Coronary
Cardiovascular Agents
Clinical Trials as Topic
Coronary Disease
Drug Utilization
Evidence-Based Medicine
Middle Aged
Patient Selection
Practice Patterns, Physicians'
Referral and Consultation
Retrospective Studies
Time Factors
Treatment Outcome