IMR Press / RCM / Volume 10 / Issue S2 / DOI: 10.3909/ricm10S20006

Reviews in Cardiovascular Medicine (RCM) is published by IMR Press from Volume 19 Issue 1 (2018). Previous articles were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence, and they are hosted by IMR Press on imrpress.com as a courtesy and upon agreement with MedReviews, LLC.

Open Access Review
Ischemia Is the Critical Determinant of Revascularization Benefit: An Interventionalist's Perspective of the COURAGE Trial
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1 The Christ Hospital Heart and Vascular Center/The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, OH
Rev. Cardiovasc. Med. 2009, 10(S2), 45–52; https://doi.org/10.3909/ricm10S20006
Published: 20 February 2009
Abstract
Although advances in percutaneous catheter-based interventions (PCI) for coronary artery disease have been associated with reductions in angiographic as well as clinical restenosis, no consistent reduction in the occurrence of death or nonfatal myocardial infarction (MI) has been observed either between devices (balloon vs bare-metal stent vs drug-eluting stent [DES]) or between device and medically treated patients with chronic stable coronary disease. Objective evidence of myocardial ischemia—irrespective of the methodology used to demonstrate its presence—is qualitatively and quantitatively related to the occurrence of death and/or nonfatal MI. The magnitude of ischemia is directly proportional to the magnitude of revascularization benefit (reduction in death or MI). Revascularization by PCI is more effective in reducing ischemia than medical therapy alone. The evolution of both PCI technology (DES) and adjunctive pharmacology has improved the relative magnitude and durability of PCI benefit compared with medical therapy alone.
Keywords
Ischemia
Revascularization
Coronary artery disease
Drug-eluting stents
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