(a) Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk W, Knudtson M, Dada M, Casperson P, Harris CL, Spertus JA, Shaw L, Chaitman BR, Mancini GBJ, Berman DS, Weintraub WS
(b) Weintraub WS, Barnett P, Chen S, Hartigan P, Casperson P, O’Rourke R, Boden WE, Lewis C, Veledar E, Becker E, Culler S, Kolm P, Mahoney EM, Dunbar SB, Deaton C, O’Brien B, Goeree R, Blackhouse G, Nease R, Spertus J, Kaufman S, Teo K
(c) Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini J, Weintraub WS

(a) Design and rationale of the Clinical Outcomes Utilizing Revascularization and Aggressive DruG Evaluation (COURAGE) trial: Veterans Affairs Cooperative Studies Program no. 424
(b) Economics methods in the Clinical Outcomes Utilizing percutaneous coronary Revascularization and Aggressive Guideline-driven drug Evaluation (COURAGE) trial
(c) Optimal medical therapy with or without PCI for stable coronary disease

(a) Am Heart J 2006;151:1173–9
(b) Am Heart J 2006;151:1180–5
(c) N Engl J Med 2007;356:1503–16

Coronary heart disease

To assess clinical endpoints (death and nonfatal MI) and healthcare outcomes (resources, quality of life and cost-effectiveness) in patients with coronary heart disease receiving intensive medical therapy with or without revascularisation

Randomised

Median 4.6 years

2287 patients (1149 PCI with optimal medical therapy, 1138 optimal medical therapy alone) with myocardial ischaemia and angiographically confirmed single or multivessel coronary artery disease

Optimal medical therapy including ASA or clopidogrel, long-acting metoprolol and/or amlodopine, lisinopril or losartan, simvastatin and isosorbide 5-mononitrate with or without PCI

The composite primary outcome of death from any cause and nonfatal MI occurred in 211 patients in the PCI group and in 202 patients in the medical therapy group (19% vs 18.5%, hazard ratio 1.05, 95% CI 0.87–1.27; p = 0.62). There were no significant differences between groups in the composite of death, MI and stroke, hospitalisation for acute coronary syndrome or MI

This study has been the basis for a number of publications. A selection of references:

Chronic kidney disease
– Sedlis SP et al, Am J Cardiol 2009;104:1647–53

Long-term follow-up
– Boden WE et al, Am J Cardiol 2009;104:1–4

Myocardial perfusion single photon emission computed tomography for assessing ischaemia
– Shaw LJ et al, J Nucl Cardiol 2006;13:685–98
– Shaw LJ et al, Circulation 2008;117:1283–91

Quality of life
– Maron DJ et al, Am J Cardiol 2009;104:1055–62