Harvard Heart Letter

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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