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COURAGE Sub-study: PCI Outperforms Drugs-Only
Date:11/6/2007

cipal investigator and a professor of medicine at Emory University, who presented the late-breaking clinical trial at the AHA Scientific Sessions.

Using a nuclear imaging technique called "single photon emission computed tomography" (SPECT), the study showed that patients with moderate to severe ischemia benefited most from PCI when compared with those who received only optimal medical therapy. In fact, when ischemia was reduced, the risk of death was also reduced. This finding confirms cardiologists' general understanding of heart disease -- that significant ischemia is not in a patient's best long- term interests.

The SPECT images, which enable physicians to assess the blood flow to the heart, showed that some patients had a very significant reduction in ischemia (more than 5 percent). Of patients who underwent PCI and took medications, 33 percent showed a reduction in ischemia of 5 percent or more, compared with only 19 percent of patients who took only medications.

"This study also confirms the importance of identifying patients who are at most risk and who can therefore most benefit from PCI," Dr. Weiner said.

Among the patients who had reduced ischemia, nearly 80 percent of both treatment groups were free of angina, which is characterized by chest pain that can be debilitating. PCI in addition to medications is clearly more effective than a medications-only approach in patients with high-risk ischemia (those with greater than 5 percent of their heart muscle compromised), according to the study.

The COURAGE trial received widespread attention earlier this year when some concluded that PCI offered no reduction in the risk of death or heart attack in patients with stable coronary artery disease compared with using only drugs.

The overall COURAGE trial looked at a narrow group of relatively healthy, stable patients who represented only about 30 percent of patients treated by interventional cardiologists. The nuclear sub-study de
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SOURCE Society for Cardiovascular Angiography and Interventions(SCAI)
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