Optimal medical therapy (OMT) has previously been shown to lead to similar rates of cardiovascular events as percutaneous coronary intervention (PCI) in patients with stable coronary artery disease.  Most noticeably, the COURAGE trial showed that PCI did not improve patient survival or prevent myocardial infarction.  However, it is also known that the findings of important clinical trials may take some time to translate into everyday clinical practice, therefore the objective of this study was to examine the use of OMT in patients undergoing PCI both before and after the publication of the COURAGE trial.

Borden et al. performed an observational study of patients with stable CAD undergoing PCI in the National Cardiovascular Data Registry between September 1, 2005, and June 30, 2009.  Optimal medical therapy was defined as either being prescribed (or having documented contraindication to) an anti-platelet agent, beta-blocker, or statin.  Among the 467,211 patients included in the study, OMT was used in 206,569 (44.2%) before PCI and in 303,864 patients (65.0%) at discharge following PCI.  Although the COURAGE trial did see an increase in the number of patients on OMT before PCI (75,381 vs. 131,188; P<0.001), overall still less than half of all patients (44.7%) were receiving OMT prior to PCI.  The use of OMT at discharge following PCI also showed only a small rise (63.5% to 66.0%; P<0.001).

Conclusions:

The COURAGE trial has had relatively little impact on the use of OMT in patients undergoing PCI.  OMT remains largely underused in interventional strategies.

• Borden WB, Redberg RF, Mushlin AI et al.  Patterns and Intensity of Medical Therapy in Patients Undergoing Percutaneous Coronary Intervention.  JAMA 2011;305:1882-1889.