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Editorials

When Is Better Not Good Enough?

Insights From the COURAGE Economic Study

Ajay J. Kirtane, MD, SM and David J. Cohen, MD, MSc

From Columbia University Medical Center/New York Presbyterian Hospital and the Cardiovascular Research Foundation, New York, NY (A.J.K.); Saint Luke’s Mid America Heart Institute, Kansas City, Mo (D.J.C.).

Correspondence to David J. Cohen, MD, MSc, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111. E-mail dcohen@saint-lukes.org

Key Words: Editorials • cost–benefit analysis • epidemiology • angioplasty • transluminal • percutaneous

An extract of the first 250 words of the full text is provided, because this article has no abstract.

More than 800 000 percutaneous coronary intervention (PCI) procedures are performed annually in the United States alone at a cost of more than $10 billion. Although many of these procedures are performed on patients with symptoms such as acute myocardial infarction and unstable angina, for whom randomized clinical trials have demonstrated substantial benefits including prevention of myocardial infarction and reduced mortality rate,^1,2 approximately half of all PCI procedures are performed on patients with stable coronary artery disease. In this setting, PCI has been shown to improve anginal symptoms and quality of life; however, it has not significantly affected clinical outcomes such as death and nonfatal myocardial infarction in prior randomized trials.^3,4 Given the substantial economic burden of these procedures and the modest clinical benefits to patients with stable coronary artery disease, it is therefore not surprising that PCI—and particularly, elective PCI for stable patients—is a prime target for economic evaluation.

Article see p 12

As such, the article by Weintraub et al⁵ in this issue of Circulation: Cardiovascular Quality and Outcomes, which describes the results of a prospective in-trial and lifetime cost–utility analysis performed alongside the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluations) trial, is a welcome addition to the cardiovascular literature. COURAGE was a randomized clinical trial that compared PCI with optimal medical therapy (PCI+OMT) versus OMT alone as initial management strategies for patients with stable coronary artery disease. As previously described, at a median follow-up of 4.6 years, there were no significant differences between the . . . [Full Text of this Article]

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Circ Cardiovasc Qual Outcomes 2008 1: 12-20. [Abstract] [Full Text] [PDF]

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