Do Clinical Trials In Ischemic Heart Disease Meet the Needs of Those With Ischemia?

Since 1990, multiple randomized clinical trials (RCTs) and subsequent meta-analyses have compared the outcome of percutaneous coronary intervention (PCI) medical therapy for stable ischemic heart disease with no difference in primary outcome (death and/or myocardial infarction [MI]) between the 2 approaches. Only recently--in the era of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial (1) and the FAME (Fractional Flow Reserve Versus Angiography for Multivessel Evaluation) trial (2)--that the fundamental prognostic significance of inducible ischemia has been more appreciated, and even then not entirely consistently. [...]the COURAGE trial conclusively demonstrated that PCI as an initial therapeutic strategy does not reduce the risk of death, MI, or other major cardiovascular events when added to optimal medical therapy (OMT) in patients with stable ischemic heart disease.