Medical Versus Revascularization Approach for Stable CAD

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Sunday, April 3, 12:30-1:45 PM

A substudy of the COURAGE trial by Maron et al found that lifestyle and pharmacologic interventions with or without PCI in patients with stable coronary artery disease (CAD) proved to be a successful measure of secondary prevention. Researchers said the approach has "potential policy implications regarding the use of nurse case mangers and free medications to optimally manage patients with chronic CAD."

Others, however, argue that COURAGE results are too impractical, expensive, or difficult to replicate in practice. It's unclear how much the free medication administered during the trial influenced compliance and, therefore, outcomes.

The COURAGE trial itself found that optimal medical therapy plus PCI offered no benefit in terms of mortality or subsequent MI compared with optimal medical therapy alone.

However, another aspect of treating stable CAD is the difference in presentation and response to conventional treatment between men and women. Atherosclerosis in women presents more diffusely and treatments aimed at plaque regression do not always result in the reduction of angina. In some women, however, PCI was shown to bring relief.

In this "Lunch With the Experts" session, there will case presentations and discussion, with much room for questions from attendees. Patients with stable CAD can be challenging and these experts will be able to shed light on treatment options.

Speaker Information

  • Sanjay Kaul, MD, Cedars-Sinai Heart Institute, Los Angeles – Chair
  • Gautam Kedia, MD, Cedars-Sinai Heart Institute, Los Angeles -- Case Presenter
  • William E. Boden, MD, University at Buffalo Schools of Medicine & Public Health, Buffalo, N.Y. -- Panelist
  • Bernard J. Gersh, MD, Mayo Clinic, Rochester, Minn. – Panelist
  • Spencer B. King, III, MD, Saint Joseph's Heart and Vascular Institute, Atlanta -- Panelist
  • Michael J. Mack, MD, Baylor Healthcare System, Plano, Texas -- Panelist