The COURAGE trial (2007) compared optimal medical therapy (OMT) alone versus PCI plus OMT in stable ischemic heart disease. What was the primary finding?

• A PCI significantly reduced all-cause mortality compared to OMT alone
• B PCI did not reduce death or MI compared to OMT in stable CAD ✓
• C PCI reduced non-fatal MI but not mortality compared to OMT
• D PCI reduced angina but increased MI rate at 5 years

Explanation

The COURAGE trial demonstrated that PCI added to optimal medical therapy did not reduce death, MI, or other major cardiovascular events compared to OMT alone in patients with stable ischemic heart disease. This was confirmed by the ISCHEMIA trial. PCI did provide better initial angina relief but the advantage diminished over time. This evidence underpins current guidelines recommending OMT as first-line therapy for stable CAD.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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