| Placing COURAGE in context: review of the recent literature on managing stable coronary artery disease. | |
| | |
MedLine Citation:
|
PMID: 18613996 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Coronary artery disease (CAD) is the leading cause of death in the United States, but prevention and intervention efforts are lowering mortality. This progress is being undercut by rising rates of obesity and diabetes, and adherence to evidence-based prevention efforts is less than ideal. Many patients with CAD who are asymptomatic or have minimal symptoms undergo percutaneous coronary intervention (PCI) each year, even though PCI has not been demonstrated to improve survival for this group. Motivated by the recent controversy surrounding the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial, we reviewed randomized clinical trials with follow-up published in the past decade comparing medical management with revascularization for stable CAD to provide a context for the COURAGE trial. We searched for relevant studies published from January 1, 1997, until the date of electronic publication of the COURAGE study results, March 26, 2007; references cited in the COURAGE publication were also reviewed. Evidence shows that PCI does not decrease mortality or risk of myocardial infarction over optimal medical or lifestyle therapy in patients with chronic stable CAD. In published studies, early benefits in angina control afforded by revascularization wane over time; this could change with modern interventional therapies. The final word is not that medical therapy is superior for all patients, but that optimizing medical and lifestyle therapy is appropriate as an initial management strategy for most patients who do not have unstable or disabling symptoms. It is essential that systems are set in place to make the medical management of patients with CAD second nature; this focus could be one of the most powerful results of the COURAGE trial. |
| | |
Authors:
|
Megan Coylewright; Roger S Blumenthal; Wendy Post |
Related Documents
:
|
6154116 - Unifocal origin of multiform extrasystoles in concealed bigeminy. 21864816 - Impact of smoking on outcomes of patients with st-segment elevation myocardial infarcti... |
Publication Detail:
|
Type: Journal Article; Review |
Journal Detail:
|
Title: Mayo Clinic proceedings. Mayo Clinic Volume: 83 ISSN: 1942-5546 ISO Abbreviation: Mayo Clin. Proc. Publication Date: 2008 Jul |
Date Detail:
|
Created Date: 2008-07-10 Completed Date: 2008-07-22 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0405543 Medline TA: Mayo Clin Proc Country: United States |
Other Details:
|
Languages: eng Pagination: 799-805 Citation Subset: AIM; IM |
Affiliation:
|
Department of Medicine, Johns Hopkins University, Baltimore, MD, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Coronary Disease*
/
etiology,
mortality,
therapy Humans Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use* Myocardial Revascularization / utilization* Outcome Assessment (Health Care) / methods* Randomized Controlled Trials as Topic / methods Risk Factors Survival Rate / trends United States / epidemiology |
| Chemical | |
Reg. No./Substance:
|
0/Hydroxymethylglutaryl-CoA Reductase Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Subspecialty differences in asthma characteristics and management.
Next Document: Importance of low-grade albuminuria.