36th Annual Tutorials in the Tetons Update in Cardiovascular Disease, day 1---PCI in stable coronary disease

Spencer King is arguably the world’s leading expert on percutaneous coronary intervention. At Emory he did some of the pioneering work in the field. He is currently President of the Heart and Vascular Institute at Saint Joseph’s Hospital in Atlanta and Professor Emeritus at Emory. His topic, the role of PCI in stable coronary disease, was very timely because it took center stage in the health care reform debates.

In the spotlight were COURAGE and BARI 2D, two trials which were egregiously hyped by the popular media and some bloggers. It was purported that these studies compared PCI with medical therapy. That was not the case. In fact, COURAGE and BARI 2D (and even this is an oversimplification) compared, in patients on optimal medical therapy, PCI as an initial strategy versus a strategy of watchful waiting, with PCI deferred and reserved for patients with progressive symptoms or instability. It turned out that the deferred PCI strategy was acceptable, but keep in mind that many patients on optimal medical management, about one third in COURAGE, required PCI on clinical grounds. (BARI 2D was much more complex and had other arms, beyond the scope of this discussion).