COURAGE not followed by action

Results of landmark trial have little effect on use of angioplasty.

The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial should have been a game changer for people with stable angina (chest pain from cholesterol-clogged coronary arteries) or a severe narrowing in one or more coronary arteries. In such individuals, COURAGE showed that artery-widening angioplasty plus stent implantation was no better than optimal medical therapy at preventing heart attacks or improving survival. In other words, it made sense to first try medical therapy — that is, drug treatment and lifestyle changes — and turn to angioplasty if it didn't work.

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