What is the COURAGE trial?

The COURAGE trial is a large study that made a big splash in 2007 when its results were announced at a major medical meeting and simultaneously published in a prestigious medical journal. COURAGE studied the outcomes of two groups of patients with stable heart disease, meaning they had been diagnosed with heart disease but were not at immediate risk for a heart attack. One group received medications only to manage their heart disease, while the other group received medication as well as a stent. For background, a stent is a medical device that helps to prop open a blocked artery in the heart and can also relieve chronic chest pain, called angina, associated with a heart blockage. In COURAGE, 66 percent of patients had angina.

Researchers monitored the two groups and tracked the number of patients in each group who experienced a heart attack or died. The final results showed patients who were treated with medications only were just as likely to have a heart attack or die as the patients who were treated with a stent and medication after they underwent an angiogram to evaluate the extent of underlying coronary disease.

COURAGE received significant attention mainly because medications alone are typically a less expensive and less invasive therapy, so based on the results, the logical option for treating stable heart disease may seem like medications only. However, COURAGE only studied a sub-set of relatively healthy patients who were able to stick to a strict medication regimen and set of lifestyle changes - something many average patients cannot maintain over long periods of time. Also, the data showed patients with moderate to severe angina reduced their risk of death when treated with a stent and medication regimen, and their quality of life improved when they no longer experienced frequent chest pain.

Ultimately, the COURAGE trial reaffirmed what interventional cardiologists have known all along - each patient needs to be treated on a case-by-case basis. Patients and doctors should discuss all of the treatment options available for heart disease and determine the best choices for each patient’s needs. Patients who undergo a stent procedure take medications to lower cholesterol and prevent blood clots.