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Optimal medical therapy with or without PCI for stable coronary disease

One-paragraph summary

COURAGE randomized 2,287 patients with stable coronary disease and objective ischemia to PCI plus optimal medical therapy (OMT) or OMT alone. Over median 4.6 years, the primary outcome of death or nonfatal MI occurred in 19.0% versus 18.5% (HR 1.05, 95% CI 0.87–1.27), with no significant difference in other major cardiovascular outcomes reported in the primary paper (Boden 2007, PMID 17387127).

Key findings

  • Routine PCI did not reduce death or MI.
  • Intensive risk-factor and antianginal therapy was feasible in a trial system.
  • Symptom relief and event prevention were empirically separated.

Limitations

  • Pre-modern stents and lipid therapy constrain direct procedural comparison.
  • High-risk left-main and markedly unstable populations were not represented.
  • Trial adherence to OMT exceeded many real-world settings.

Why it matters

COURAGE shifted stable-CAD PCI from presumed infarct prevention toward symptom-directed use and created the question later tested under sham control and severe-ischemia selection.

Cited by wiki pages

  • Overview
  • Stable CAD management
  • Pathophysiology