Drugs and needles

PCI has been a pretty standard part of therapy for coronary heart disease for some time now, but all the while medical therapy has been out there holding the fort. There is often the misconception that getting stented is the be all and end all of stable angina, and must certainly improve mortality, when in most cases it’s a procedure only to improve morbidity. 

Surely all of these cardiology patients though are already on the right medications – and therefore PCI is the only option left?

Let’s wind back to 2007, when the COURAGE trial came out. This was a biggie – two groups of over a 1,000 patients randomised to optimal medical therapy with or without PCI as well. Importantly, the PCI group got both aspirin and clopidogrel, whereas the medical group got one or the either. The results were pretty controversial at the time – having PCI did not change rates of death and myocardial infarction, and the reduction in angina was the same.

Regardless of how you interpret the study however, it clearly underlines one thing – optimal medical therapy is critical in improving both morbidity and mortality. This study in JAMA looked at the treatment before and after the COURAGE trial – and unfortunately found that in patients with stable coronary artery disease, less than half had optimal medical therapy before PCI – and even after PCI, only two thirds were treated appropriately. 

Make sure you put your patients on the right medications before jumping for PCI – have a read over here

IMAGE cpradi


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