Medical and Catheter-Based Therapies for Managing Stable Coronary Disease: Lessons From the COURAGE Trial.

Medical and catheter-based therapies play complementary roles in treating patients with stable coronary atherosclerosis. The choice of therapy (or therapies) must be made for each patient based on coronary anatomic suitability and in the context of the patient's lifestyle, functional capacity, level of symptom limitation, and ability to take the prescribed treatment. Objective evidence of myocardial ischemia on nuclear myocardial scintigraphy is quantitatively correlated with the occurrence of death or myocardial infarction in late follow-up, and percutaneous coronary intervention added to optimal medical therapy is more effective than medical therapy alone in reducing ischemia. Coronary angiography and definition of the coronary anatomy should be performed in patients with stable angina pectoris to help in selecting the optimal treatment strategy.