Case presented does not wash

doi:10.1136/bmj.39185.447315.3A

BMJ 2007;334:813-814 (21 April), doi:10.1136/bmj.39185.447315.3A

Letters

Coronary artery disease

Case presented does not wash

The first 150 words of the full text of this article appear below.

COURAGE comes hard on the heels of a recent cost effectivenessanalysis that showed that the huge costs of angioplasty comparedwith medical treatment could not be justified.¹ ² The studyconfirms that angioplasty does not improve prognosis in patientswith stable angina, and this should clarify a common misunderstandingin the minds of commissioners and patients.³

Thomas (previous letter) says that it is important to note that43% of patients in the COURAGE study had little or no angina.It is worrying that such patients should have been exposed tothe risk of harm that is inherent in palliative angioplasty,but Thomas should recall that the proportion of patients randomisedto palliative angioplasty in the landmark RITA trial was 45%.⁴

The finding that one third of the COURAGE patients randomisedto medical treatment later underwent angioplasty should be balancedby the fact that 20% of the angioplasty group also underwent. . . [Full text of this article]

Michael R Chester, director

National Refractory Angina Centre, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool L14 3PE

mike@angina.org

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