Study finds coronary procedure adds no benefit over 'optimal medical ther...( g-eluting stents which are coated with...),Health

g-eluting stents, which are coated with medications that help prevent scarring, were not approved until the trial was nearly completed, only 31 COURAGE patients received this type of stent. But studies have shown little difference between coated and non-coated stents in their ability to prevent heart attacks and deaths.

At a median follow-up of almost five years, the rates of death, nonfatal heart attack, stroke, and hospitalization for heart disease were the same in the two study groups: those who received only OMT, and those who received PCI plus OMT.

There were also no differences between the groups in cholesterol levels, blood pressure levels, or blood-sugar control. The groups also made lifestyle changes at similar rates: After five years, 75 percent of patients in both groups were following the recommended diet, and about 40 percent were getting regular exercise. The PCI group was more likely to report relief from angina throughout most of the follow-up period, but this difference disappeared over five years of follow-up.

"People assume that once you have PCI, it's curative," said first author and presenter William E. Boden, MD. "I think the best we can say is that it's palliative." Boden is a consultant in cardiology at the Western New York VA Healthcare System in Buffalo. He is also the medical director of Cardiovascular Services for Kaleida Health, chief of cardiology for Buffalo General and Millard Fillmore hospitals, and professor of medicine and public health at the University of New York at Buffalo School of Medicine and Biomedical Sciences.

According to Peter Liu, MD, scientific director of the CIHR Institute of Circulatory and Respiratory Health, "The findings suggest that if a patient with heart disease is doing well, the latest available medications are very effective and there is no need for PCI."

PCI has been shown to help patients with more severe heart disease. However, prior to COURAG
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Contact: James Blue
james.blue@va.gov
212-807-3429
Veterans Affairs Research
27-Mar-2007

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