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To Stent or Not: Is That the Question?

Reporting of COURAGE study results confused the public about the need and benefits of angioplasty

PORTLAND, Ore., June 07, 2007 /PRNewswire/ -- The onslaught of anti-stent news reports over the past few months has shaped the public's view that angioplasty doesn't work and its use should decrease. Confused by the media coverage, patients have extensively questioned their cardiologists about the benefits of stenting.

"Doctor and patient dialogue is always good," said Dr. Skip Freedman, Executive Medical Director for AllMed Healthcare Management. "But there's really no controversy over the COURAGE study, because it says that nothing has really changed." COURAGE is short for the full study name Clinical Outcomes Utilizing Revascularization and Aggressive Guideline Driven Drug Evaluation.

Many consumers have misread stories in the press about stents and angioplasty as involving patients undergoing a heart attack and in dire need of either angioplasty or clot-busting medications. But this wasn't the case. The COURAGE study looked at only rather low-risk patients who are in a stable condition.

The real message is that the study reinforces long-standing clinical practice guidelines for chronic stable angina from the of Cardiology and the American Heart Association. These treatment guidelines recommend that stable angina patients start with the best medical therapy and only receive angioplasty if their chest pain continues. What the study shows is how effective medication is for fairly low-risk patients who are in a stable condition.

Has anything changed?

"The study shows that patients have a choice -- they can delay stent implantation if medication and lifestyle changes provide satisfactory freedom from symptoms," said Freedman, who is also an emergency room physician. "It says that doctors must use medication aggressively and counsel low-risk patients about the trade-offs of the two
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