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Lessons from major heart trial need implementation
Date:5/10/2011

treat them," says co-author Dr. Alvin I. Mushlin, chairman of the Department of Public Health at Weill Cornell Medical College and public health physician-in-chief at NewYork-Presbyterian Hospital/Weill Cornell Medical Center.

In this study, the research team, which includes investigators from the University of California at San Francisco, Duke Clinical Research Institute, and the University of Missouri, sought to see if heart care changed after publication of the $33.5 million COURAGE clinical trial in the New England Journal of Medicine in 2007.

In COURAGE, 2,287 patients with stable coronary artery disease (CAD) were randomized to receive either "optimal medical therapy" alone or the same therapy along with a stent -- a device that presses artery-clogging plaque back against a vessel wall. Optimal medical therapy was sought with all patients, even those having stents placed, assigning them to receive common cardiac agents -- a statin drug, a beta blocker, and aspirin or thienopyridine.

COURAGE investigators found there was no difference in the outcomes of the two groups, except for angina symptoms, which demonstrated that adding stenting to optimal medical therapy is not better than the ability of optimal medical therapy alone to prevent heart attacks and death in patients with stable CAD. Even before COURAGE was published, other studies had shown that medical therapy was beneficial in these patients and its use was encouraged by established cardiac care guidelines.

While previous investigators have shown that translation of clinical trials into patient practice has been "suboptimal," no one had looked at whether this is true in patients who receive a stent through percutaneous coronary intervention (PCI), which is a common and costly procedure, says Dr. Borden.

To find out, the researchers studied 1,013 U.S. hospitals in what they believe to be the largest PCI registry in the United States -- the CathPCI registr
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Contact: Andrew Klein
ank2017@med.cornell.edu
212-821-0560
New York- Presbyterian Hospital/Weill Cornell Medical Center/Weill Cornell Medical College
Source:Eurekalert

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