Sarah Goodwin

Kathi Ovnic
Holly Korschun
October 4, 1999

One of the most ambitious efforts to date comparing revascularization (via coronary angioplasty) with "best medical care" has begun at 38 sites in the United States and Canada.

"Best medical care" refers to the spectrum of behavioral and pharmacological therapies and prevention tactics used to treat and prevent coronary artery disease, says Emory cardiologist William Weintraub, M.D., co-principal investigator of the COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial. He will work closely with the other co-principal investigators William Boden, M.D., of Syracuse Veterans Affairs Medical Center, NY, and Robert A. O'Rourke, M.D., of the San Antonio Veterans Affairs Medical Center.

"This study is extremely important to cardiology in general and to Emory in particular,"says Dr. Weintraub, who, as director of The Emory Center for Outcomes Research (ECOR), will head the economics, quality-of-life and cost-effectiveness cores for the trial. ECOR colleague Leslee Shaw, Ph.D., will lead the studywide nuclear analytic core. They will collaborate with many other ECOR researchers at the Emory University School of Medicine, Emory's Rollins School of Public Health and Emory's Nell Hodgson Woodruff School of Nursing. "Our leadership role in this trial ­ one of the most significant studies of this decade -- not only gives Emory the opportunity to call upon its strong cardiac epidemiology program, it gives us another opportunity to objectively evaluate all the options available for treating coronary artery disease." An anticipated 3,260 heart patients will be recruited to participate in the seven-year, $35 million COURAGE trial.

Emory faculty will run two Atlanta recruitment sites: one at the Atlanta Veterans Affairs Medical Center led by Emory cardiologist Mark E. Leimbach, M.D., and another site at Emory University Hospital, led by Emory cardiologist Steven V. Manoukian, M.D., assistant professor of medicine (cardiology).

Qualified participants must have untreated coronary artery disease with documented ischemia. Ischemia occurs when the coronary arteries become so narrowed by arteriosclerosis that they cannot fully nourish the heart muscle with blood. The severe chest pain associated with ischemia is known as angina. COURAGE study participants will mostly have persistent Class II-IV angina.

Volunteers will be randomized to either receive balloon angioplasty, plus "best medical care" or "best medical care" alone. Lifestyle changes and medications that control cholesterol, high blood pressure, chest pain known as angina and irregular heartbeats known as arrhythmias are all part of "best medical care," as is counseling that encourages patients to make lifestyle changes aimed at weight loss, increased exercise and smoking cessation.

The trial is sponsored by the Department of Veterans Affairs; The Medical Research Council of Canada; Merck Inc.; Pfizer; DuPont Fujisawa and several companies providing pharmaceuticals and devices.

Information about the COURAGE trial and ECOR is available at the following website: