Related Experiment Video
Updated: May 3, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Patterns and intensity of medical therapy in patients undergoing percutaneous coronary intervention
William B Borden1, Rita F Redberg, Alvin I Mushlin
1Department of Medicine, Weill Cornell Medical College, Cornell University, 1305 York Ave, Eighth Floor, New York, NY 10021, USA. wbb2001@med.cornell.edu
Insights
Optimal medical therapy (OMT) use in stable coronary artery disease (CAD) patients undergoing percutaneous coronary intervention (PCI) remained low before procedures and only modestly increased after the COURAGE trial. Post-PCI OMT use was higher but saw little change.
Area of Science:
- Cardiology
- Clinical Trials
- Health Services Research
Background:
- The COURAGE trial indicated optimal medical therapy (OMT) is crucial for stable coronary artery disease (CAD) before percutaneous coronary intervention (PCI).
- It remains unclear how frequently OMT is implemented in routine practice before PCI.
- The study investigates changes in OMT use post-COURAGE trial publication.
Purpose of the Study:
- To assess the utilization of OMT in patients with stable angina undergoing PCI.
- To compare OMT use before and after the pivotal COURAGE trial publication.
Main Methods:
- Observational study analyzing data from the National Cardiovascular Data Registry (2005-2009).
- Included patients with stable CAD undergoing PCI.
- Defined OMT as prescription of antiplatelet, beta-blocker, and statin, or documented contraindication.
Main Results:
- OMT was used in 44.2% of patients before PCI and 65.0% at discharge.
- Pre-PCI OMT use was 43.5% before and 44.7% after the COURAGE trial (P < .001).
- Post-PCI OMT use was 63.5% before and 66.0% after the COURAGE trial (P < .001).
Conclusions:
- Less than half of stable CAD patients received OMT before PCI.
- Approximately two-thirds received OMT at discharge post-PCI.
- Practice patterns for OMT use showed minimal change after the COURAGE trial.
Context:
The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) study, which provided optimal medical therapy (OMT) to all patients and demonstrated no incremental advantage of percutaneous coronary intervention (PCI) on outcomes other than angina-related quality of life in stable coronary artery disease (CAD), suggests that a trial of OMT is warranted before PCI. It is unknown to what degree OMT is applied before PCI in routine practice or whether its use increased after the COURAGE trial.
Objective:
To examine the use of OMT in patients with stable angina undergoing PCI before and after the publication of the COURAGE trial.
Design, Setting, And Participants:
An observational study of patients with stable CAD undergoing PCI in the National Cardiovascular Data Registry between September 1, 2005, and June 30, 2009. Analysis compared use of OMT, both before PCI and at the time of discharge, before and after the publication of the COURAGE trial. Optimal medical therapy was defined as either being prescribed or having a documented contraindication to all medicines (antiplatelet agent, β-blocker, and statin).
Main Outcome Measures:
Rates of OMT before PCI and at discharge (following PCI) between the 2 study periods.
Results:
Among all 467,211 patients (173,416 before [37.1%] and 293,795 after [62.9%] the COURAGE trial) meeting study criteria, OMT was used in 206,569 patients (44.2%; 95% confidence interval [CI], 44.1%-44.4%) before PCI and in 303,864 patients (65.0%; 95% CI, 64.9%-65.2%) at discharge following PCI (P < .001). Before PCI, OMT was applied in 75,381 patients (43.5%; 95% CI, 43.2%-43.7%) before the COURAGE trial and in 131,188 patients (44.7%; 95% CI, 44.5%-44.8%) after the COURAGE trial (P < .001). The use of OMT at discharge following PCI before and after the COURAGE trial was 63.5% (95% CI, 63.3%-63.7%) and 66.0% (95% CI, 65.8%-66.1%), respectively (P < .001).
Conclusion:
Among patients with stable CAD undergoing PCI, less than half were receiving OMT before PCI and approximately two-thirds were receiving OMT at discharge following PCI, with relatively little change in these practice patterns after publication of the COURAGE trial.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:14Myocarditis III: Medical Management
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:26Angina IV: Management
01:27Peripheral Artery Disease III: Interprofessional Care