Medical Therapy as Good as PCI in Stable Disease : The estimated rate of death or nonfatal MI was 19.0% with PCI and 18.5% with medical therapy.

Dr. Gregory J. Dehmer, president of the Society for Cardiovascular Angiography and Interventions (SCAI), said that the proportion of PCI procedures in patients with stable CAD is far lower than the COURAGE researchers' estimate. Most PCI procedures are performed in patients having severe acute MIs, those with unstable angina, and those with high-risk disease characteristics that would have made them ineligible for inclusion for the COURAGE trial, he said in an interview.

Also at the press briefing, Dr. William S. Weintraub of Christiana Hospital in Wilmington, Del., released lifestyle and economic findings of the study. Both optimal medical therapy and PCI quickly and markedly improved patients' angina frequency and quality of life.

Over most of the course of the study, PCI held a slight edge over medication in terms of reducing angina symptoms, leading to a significant but “very slight trend” to improved quality-of-life-years, he said.

The incremental cost-effectiveness ratio at 3 years favored PCI by $217,000, meaning that the cost of the procedure was beneficial in terms of quality of life gained.

The COURAGE study was funded by the U.S. Department of Veterans Affairs Office of Research and Development, the Canadian Institute of Health, and unrestricted grants from Merck & Co., Pfizer, Bristol-Myers Squibb, Fujisawa Healthcare Inc., Kos Pharmaceuticals Inc., Datascope Corp., Astra-Zeneca Pharmaceuticals, Key Pharmaceuticals, Sanofi-Aventis, First Horizon Pharmaceutical Corp, and GE Healthcare.