The COURAGE study has stimulated intensive discussion about the optimal approach to treatment of patients with stable angina. To some, the study implied that PCI has no clinical benefit versus optimal medical therapy but this is open to alternative considered interpretation. To the interventionalist who deploys optimal medical therapy responsibly, the study highlights the importance of the concept of an ischaemia driven approach. The availability of the pressure wire has provided cardiologists with an important additional tool with which to tailor the delivery of revascularisation to not just the ischaemic patient but also to the ischaemic lesion. Such a strategy applied to COURAGE (and perhaps also to SYNTAX) might provide a very different comparative outcome.
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Competing interests None.
Provenance and Peer review Commissioned; not externally peer reviewed.