In the COURAGE trial, which important conclusion was drawn regarding percutaneous coronary intervention (PCI) for stable ischemic heart disease?
- A PCI reduces mortality compared to optimal medical therapy alone
- B PCI does not reduce death or MI compared to optimal medical therapy, but provides superior symptom relief initially ✓
- C PCI reduces the risk of myocardial infarction compared to optimal medical therapy
- D PCI should not be performed in stable angina under any circumstances
Correct answer: B. PCI does not reduce death or MI compared to optimal medical therapy, but provides superior symptom relief initially
Explanation
The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial compared PCI plus optimal medical therapy (OMT) versus OMT alone in stable ischemic heart disease. PCI offered no reduction in death or MI compared to OMT over 4.6 years of follow-up, but provided superior initial relief of anginal symptoms. The ISCHEMIA trial subsequently reinforced that an invasive strategy does not reduce MACE in most stable patients with moderate-severe ischemia on non-invasive testing. These findings fundamentally support OMT-first in stable angina.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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