Insights From the COURAGE Economic Study

More than 800 000 percutaneous coronary intervention (PCI) procedures are performed annually in the United States alone at a cost of more than $10 billion. Although many of these procedures are performed on patients with symptoms such as acute myocardial infarction and unstable angina, for whom randomized clinical trials have demonstrated substantial benefits including prevention of myocardial infarction and reduced mortality rate,1,2 approximately half of all PCI procedures are performed on patients with stable coronary artery disease. In this setting, PCI has been shown to improve anginal symptoms and quality of life; however, it has not significantly affected clinical outcomes such as death and nonfatal myocardial infarction in prior randomized trials.3,4 Given the substantial economic burden of these procedures and the modest clinical benefits to patients with stable coronary artery disease, it is therefore not surprising that PCI—and particularly, elective PCI for stable patients—is a prime target for economic evaluation.