What's the best way to "fix" a narrowed coronary artery? That question was the crux of a multimillion-dollar trial dubbed COURAGE, short for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation. Its results, presented in the spring of 2007, stunned some doctors and seemed to shock the media, but we hope they won't come as a surprise to readers: For people with stable coronary artery disease (clogged arteries nourishing the heart), artery-opening angioplasty was no better than medications and lifestyle changes at preventing future heart attacks or strokes, nor did it extend life.
The media tended to play up the COURAGE results, which were presented at the American College of Cardiology's annual meeting in March, as a David slays Goliath story. But it wasn't that at all.
Before going any further, it's important to stress that this trial compared angioplasty and medical therapy only for stable angina (chest pain on exertion) or narrowed coronary arteries that don't cause any symptoms. For a sudden blockage of a coronary artery, emergency artery-opening balloon angioplasty followed by the placement of a stent is the best remedy around.
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