Impact of optimal medical therapy and percutaneous coronary intervention on patients with stable angina.

Percutaneous coronary intervention (PCI) is not associated with reduction in risk of death or myocardial infarction in patients who have chronic stable angina with normal left ventricular function and moderate coronary artery disease. A substudy of the COURAGE trial has shown that both PCI plus optimal medical therapy (OMT) and OMT alone result in marked improvements in quality of life and angina, but that PCI can substantially benefit patients with more-severe and more-frequent angina. A number of caveats to this study exist, including the extent to which the findings can be applied to the general patient population and the large proportion of patients who had mild angina or were asymptomatic--it is difficult to make these patients feel better. In addition, the remarkable commitment of both healthcare providers and patients in this study would be hard to achieve in clinical practice. Nevertheless, for patients with mild or no angina and no significant ischemia on stress testing, the COURAGE trial reassures us that OMT alone can be efficacious in reducing angina and/or improving quality of life.