Did the COURAGE trial kill stenting?
Dr. Kussmaul: It started to. But we need to keep in mind that the patients in the COURAGE trial were either asymptomatic or had very stable angina. There is no question that patients admitted to the hospital with unstable angina or acute myocardial infarctions benefit from stenting. The COURAGE trial showed that stable and asymptomatic patients should be managed medically, and only taken to the cath lab if they have symptoms. This isn’t really a big revelation. It’s appropriate to try conservative measures with patients first, and optimizing their medications is a great place to start. Dr. Val: So does controversy remain about which kind of stents to use? Dr. Kussmaul: Yes, the pendulum has swung pretty hard on this issue. … Drug-eluting stents took the field by storm in 2003, promising the prevention of restenosis. But with most therapies touted as a miracle cure, we find out later that there are some downsides. Unfortunately, while the stents do, in fact, prevent restenosis, we’ve di
