Turn on cookies to sign in
Signing in saves your progress to your Curie account. We can only do that with cookies on — turn them on to continue.
Decades of follow-up data still can't make a case for upfront stenting in stable coronary artery disease. Extended results from the COURAGE (up to 25 years) and ISCHEMIA (up to 11 years) trials show no meaningful difference in death or heart attack rates between patients who received early PCI and those managed with medication alone. For most stable CAD patients, a conservative approach is just as safe.
Two landmark cardiology trials just got even longer follow-up — and their verdict hasn't changed. Extended data from the COURAGE and ISCHEMIA trials, presented at the American Heart Association annual meeting and published simultaneously in JAMA, confirm that upfront percutaneous coronary intervention (PCI) offers no survival advantage over optimal medical therapy (OMT) in patients with stable coronary artery disease (CAD), even across decades of observation.
In COURAGE, the 25-year cumulative incidence of death or heart attack was virtually identical between the PCI and OMT groups (93.3% vs. 91.0%). ISCHEMIA-EXTEND showed the same story at 11 years, with all-cause mortality nearly equal between invasive and conservative strategies (25.8% vs. 26.9%). Even patients with advanced chronic kidney disease in ISCHEMIA-CKD saw no mortality benefit from early intervention at 9 years.
By the Numbers:
Why it matters: These findings reinforce that a conservative, medication-first strategy is a safe and valid approach for most stable CAD patients. While PCI can improve quality of life and relieve angina symptoms, it doesn't extend lives — a crucial distinction for shared decision-making between clinicians and patients.
