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COURAGE
About the Trial
The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation trial randomized 2,287 patients with stable coronary artery disease to percutaneous coronary intervention plus optimal medical therapy or medical therapy alone. Over 4.6 years there was no difference in death or heart attack. PCI relieved angina better initially, but symptoms converged by 5 years. COURAGE challenged a multibillion dollar habit of stenting stable patients. Cardiology societies rewrote appropriateness criteria. ISCHEMIA later confirmed that even moderate to severe ischemia does not mandate revascularization for survival. Both trials reoriented stable coronary disease care toward aggressive medical prevention, with stents mainly used for symptom relief.
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