COURAGE CLINICAL OUTCOMES UTILIZING REVASCULARIZATION & AGGRESSIVE DRUG EVAL

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Coronary artery disease is a process that results in "hardening the arteries." When the arteries that supply blood and oxygen to your heart muscle become clogged or narrowed, a heart attack may result, or you may feel chest discomfort (angina) sometimes even while resting. The best treatment for patients like yourself with coronary artery disease is unclear. There are three kinds of approaches: treatment with medicines, coronary artery bypass (open heart) surgery, and balloon angioplasty. Balloon angioplasty has been used safely in patients like yourself for over 15 years. It is a technique for widening the narrowed arteries in the heart by either inflating a small balloon placed in the narrowed area or using a special device (rotoblator) to burrow through, or shave (directional atherectomy), plaques of calcium from the narrowed areas. Sometimes a small expandable stainless steel mesh tube (stent) is placed in the artery to assist it in remaining open. It has not been proven in patients like yourself whether those who have balloon angioplasty live longer, have fewer heart attacks, or have a better quality of life than those who only have medicine. The American Heart Association has developed guidelines for intensive treatment of patients with coronary artery disease with medicines. These medicines include aspirin, drugs that decrease the work of the heart (beta-blockers), drugs that relax the coronary arteries so that more blood can flow through the narrowed artery (nitroglycerin, calcium channel blockers), drugs that lower blood pressure, drugs that decrease cholesterol and blood fats, and for women, an estrogen supplement. In addition to medicines, these guidelines include recommendations to pay attention to diet and exercise and to stop smoking. The purpose of this study is to determine whether in patients like yourself, adding balloon angioplasty to the medical therapy suggested by the American Heart Association will result in fewer deaths and heart attacks or a better quality of life than treatment with medical therapy alone. All patients receive maximum medical therapy and half of the patients will receive a percutaneous procedure (PCI). Patients will be followed for 3-5 years to follow their cardiac symptoms.