Decision support only. Not medical advice. Consult a licensed clinician before initiating or changing therapy.

Patient 014

58y·male·white·ASCVD 10.2% · SBP 135 mmHg · LVEF 55% · Chol 202 mg/dL

1 active reversal flag

  1. CardiologyModerate

    Routine PCI for stable coronary artery disease

    Why flagged

    Elective PCI referral for stable CAD; COURAGE 2007 showed no mortality benefit over OMT alone. Recommend OMT-first review before proceeding.

    1. Prior guidance2007

      Routine PCI and stenting for significant angiographic stenoses (> 70%) in stable CAD to prevent death and myocardial infarction (Pre-2007 consensus).

    2. COURAGE2007

      PCI + OMT showed no difference in all-cause death or nonfatal MI compared to OMT alone (19.0% vs. 18.5%, p=NS).

    3. Reversal2023

      Guidelines updated

    4. Current recommendation

      ACC/AHA Guidelines: Optimal medical therapy (OMT) is the primary management strategy for stable ischemic heart disease. PCI is indicated strictly for refractory anginal symptom relief, not mortality reduction.