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 effectiveness analysis that showed that the huge costs of angioplasty compared with medical treatment could not be justified.^{1 2} The study confirms that angioplasty does not improve prognosis in patients with stable angina, and this should clarify a common misunderstanding in the minds of commissioners and patients.³

Thomas (previous letter) says that it is important to note that 43% of patients in the COURAGE study had little or no angina. It is worrying that such patients should have been exposed to the risk of harm that is inherent in palliative angioplasty, but Thomas should recall that the proportion of patients randomised to palliative angioplasty in the landmark RITA trial was 45%.⁴

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

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

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