Clinical Outcomes Utilization Revascularization and Aggressive Drug Evaluation

The COURAGE (Clinical Outcomes Utilization Revascularization and Aggressive Drug Evaluation) was released in 2007. This trial shows that percutaneous coronary intervention (PCI), also known as angioplasty, is ineffective in reducing incidences of stroke, heart attack, or death in patients with stable coronary artery disease, when paired with OMT (optimal medical therapy) (1).

While any medical research is important, it is pointless if not utilized in the medical field. Unfortunately this is the case with the results of the COURAGE trial. There was almost no appreciable change in how patients were treated after the COURAGE trial, even though it shows that it is clearly not beneficial to perform stints or angioplasty on patients with stable coronary artery disease. After COURAGE there was only a 1.5% increase in use of OMT before surgical intervention, and 2.5% increase after surgical intervention (2). While use of OMT has risen, it has risen by an almost negligible amount. This failure to recognize the importance of the COURAGE study is costing lives.     

While angioplasty is a relatively safe procedure the death rate is still .76% (3). This means that almost 8 in every 1,000 angioplasty patients dies as a direct result of the procedure. This information, when paired with the COURAGE trial implies that lives could easily be saved if a more conservative approach to PCI were taken.

Approximately 1.178 million PCI procedures were performed in 2006 (5). With a .76% death rate this equates almost 9,000 deaths due to angioplasty in 2006. Data shows that over 85% of PCI procedures were performed on patients with stable coronary artery disease (4). Given these figures it can be inferred that over 7,600 lives could have been saved if the results of the COURAGE study were put into practice.


1. http://blogs.wsj.com/health/2007/03/26/to-stent-or-not-to-stent/

2. http://jama.jamanetwork.com/article.aspx?articleid=899881

3. http://www.uamshealth.com/?id=1292&sid=1

4. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 2007;356:1503–16.

5. Roger VL, Go AS, Lloyd-Jones DM, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2011 update: a report from the American Heart Association [published correction appears in Circulation. 2011; 123(6):e240]. Circulation. 2011;123(4):e18-e209