NEJM 12 Apr 2007

A big prospective North American trial – COURAGE – confirms the message of the BMJ a fortnight ago: for chronic stable angina, percutaneous coronary intervention offers no advantage over optimal medical therapy. I wonder how this will influence practice. When a patient presents with recent-onset angina, should we have the convictions of our COURAGE and write to the cardiologist, “Please investigate this patient, with angiography if necessary, but please don’t bother with the balloons or stents until we’ve given the nitrates and calcium blockers a good try.