cardiovascularКардиоваскулярная терапия и профилактикаCardiovascular Therapy and Prevention1728-88002619-0125«SILICEA-POLIGRAF» LLCcardiovascular-1502Research ArticleОБЗОРЫREVIEWSИсследование COURAGE: обескураживают или воодушевляют его результаты?COURAGE study results: disappointing or encouraging?АроновД. М.AronovD. M.arodm@atom.ruЛупановВ. П.LupanovV. P.arodm@atom.ruФГУ Государственный научно-исследовательский центр профилактической медицины РосмедтехнологииState Research Center for Preventive Medicine, Federal Agency on High Medical TechnologiesИнститут клинической кардиологии им. А.Л. Мясникова ФГУ РКНПК Росмедтехнологии, МоскваA.L. Myasnikov Research Institute of Clinical Cardiology, Russian Cardiology Scientific and Clinical Complex, Federal Agency on High Medical Technologies, Moscow2007010119707795104Copyright © Аронов Д.М., Лупанов В.П., 19701970Аронов Д.М., Лупанов В.П.Aronov D.M., Lupanov V.P.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://cardiovascular.elpub.ru/jour/article/view/1502

На основании исследования СОURAGE рассматривается современная тактика ведения больных ишемической болезнью сердца (ИБС) со стабильной стенокардией: чрескожное коронароное вмешательство (ЧКВ) или агрессивное медикаментозное лечение. Высоко оценивается роль медикаментозной вторичной профилактики в соответствии с современными рекомендациями. Особое внимание уделено ведущей роли гиполипидемической терапии больных ИБС с применением статина и ингибитора всасывания холестерина эзетимиба. Отсутствовало достоверное различие по частоте осложнений между группой ЧКВ (n=1149) и группой оптимальной медикаментозной терапии (n=1138). Кумулятивная частота первичных событий за 4,6 лет составила 19,0% в группе ЧКВ и 18,5% в медикаментозной группе (р=0,62). Таким образом ЧКВ как начальная стратегия у больных стабильной ИБС не уменьшает риск смерти, инфаркта миокарда или сердечно-сосудистых событий, если дополняет медикаментозную терапию.

Based on СОURAGE study results (Clinical Outcomes Utilizing Percutaneous Coronary Revascularization and Aggressive Guideline-Driven Drug Evaluation), modern tactics for management of patients with coronary heart disease (CHD) and stable angina are discussed (percutaneous coronary intervention, PCI, or aggressive drug therapy with statins, aspirin, ACE inhibitors etc.). The role of secondary drug prevention, according to modern guidelines, is highly appraised. The emphasis is put on the leading role of lipid-lowering therapy with statins and ezetimibe. No significant difference was observed for complication rates in PCI group (n=1149) and optimal drug therapy (n=1138). Cumulative incidence of primary events during 4,6 years of follow-up was 19,0% and 18,5% in PCI and drug therapy groups, respectively (р=0,62). Therefore, in patients with stable CHD, PCI as a first-line strategy does not reduce the risk of death, myocardial infarction, or cardiovascular events, if combined with drug treatment.

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The authors declare that there are no conflicts of interest present.