A recent study examined the impact of COURAGE using data from the National Cardiovascular Data Registry (NCDR) and found that rates of OMT prior to PCI did not change following the trial (Borden, Redberg, et al., 2011). A recently released analysis from the Northern New England Cardiovascular Disease Study Group indicates that PCI rates among patients with stable CAD declined 26 percent shortly after the trial results were released (Neale, 2011). However, northern New England is thought to have more conservative practice patterns than other parts of the country, and these results may not reflect national trends.
Prior to the release of Borden’s study, our discussants generally thought that the trial may have been successful in changing practice by promoting a more “conservative” style. One expert said that the trial “took the pressure off interventionists from doing procedures.” Others felt that the intense publicity surrounding the trial put the issue of overuse of elective PCI in the spotlight, and this negative publicity drove interventionists to adopt a more conservative practice style. Still others appear to have interpreted the success of COURAGE less in terms of the absolute change in PCI rates than in how the trial has contributed momentum to the development and use of appropriateness criteria (discussed below).