Anatomic burden is more predictive of future outcomes than ischemic burden in patients with stable ischemic heart disease, according to results from a substudy of the COURAGE trial. In an interview, SCAI fellow Dr. Ajay Kirtane underscored the dangers of ignoring patient anatomy and misinterpreting COURAGE trial results. "A lot of people have interpreted COURAGE [to imply that] if you do a stress test and a patient is at low or intermediate risk, you don't have to cath them because revascularization is not going to make a difference," he said. "... Stress testing is just not that good. You have to use clinical judgment, but if there is a question, it's important to define the anatomy, because clearly anatomy predicts outcomes -- even in a low-risk population like COURAGE."
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