CU Anschutz researcher leads extended follow-up of landmark COURAGE trial, finding no significant difference in the risk of death or heart attack between stable patients treated with a procedure to open blocked arteries and those treated with medical therapy alone

AURORA, Colo., Nov. 13, 2026 /PRNewswire/ -- When doctors find a blockage in a patient's heart arteries, a common treatment option is a procedure to open the artery and restore blood flow. But does getting a stent actually help prevent a future heart attack or help someone live longer? 

A new study led by University of Colorado Anschutz researcher Neel Butala, MD suggests that, for people with stable coronary artery disease, adding an initial procedure to open blocked arteries to medical treatment does not significantly reduce the long-term risk of death or heart attack.

Published in JAMA and presented at the 2026 American Heart Association Scientific Sessions, the research provides an unusually long look at a longstanding question in cardiology: Does opening a blocked artery offer lasting benefits beyond those achieved through medication and other medical treatments?

"When someone is told they have a blockage in a heart artery, the natural reaction is to want to open it. While opening a coronary blockage can relieve someone's symptoms, it is unclear whether it affects  chances of having a heart attack or living longer. We wanted to look beyond whether the procedure works technically and understand what happens to patients over time," said Butala, also an assistant professor of medicine-cardiology at the CU Anschutz School of Medicine.

What did the extended COURAGE study find?

The original COURAGE trial compared two approaches to treating stable coronary artery disease: opening narrowed arteries with a procedure called percutaneous coronary intervention (PCI), commonly known as angioplasty, plus optimal medical therapy, or treating patients with optimal medical therapy alone.

During angioplasty, doctors use a small balloon to open a narrowed artery and often place a tiny metal tube called a stent to help keep it open.

For the new analysis, researchers followed 959 patients from the original trial using linked health records. After a median follow-up of 15 years, with some followed for as long as 25 years, researchers found no significant difference in the combined risk of death or heart attack between the two groups.

The estimated 25-year cumulative incidence of death or heart attack was 93.3% among patients initially assigned to PCI plus medical therapy and 91% among those assigned to medical therapy alone.

Earlier research examined long-term survival following the original trial. This analysis adds heart attack outcomes, addressing an important unanswered question about whether an initial procedure might reduce cardiovascular events over time.

What does this mean for patients?

For people with stable coronary artery disease, the findings suggest that successfully opening a narrowed artery does not necessarily translate into a lower risk of heart attack or death.

"When we open a blocked artery, we know we've improved blood flow through that artery and that relieves symptoms. But the bigger question is whether that translates into a reduction in clinical events such as heart attacks or death for patients over the long term. That's what we wanted to understand with this study," said Butala. "We found no significant difference in the risk of death or heart attack between the two treatment groups. That's important information for doctors and patients as they consider the best approach to treating stable coronary artery disease."

The findings do not mean stents or angioplasty are unnecessary. These procedures can relieve chest pain and other symptoms, and emergency interventions can be lifesaving for people experiencing certain types of heart attacks. The study specifically examined the long-term outcomes of an initial PCI strategy for patients with stable coronary disease.

The analysis was a post hoc observational follow-up of participants from the original randomized COURAGE trial, rather than a new randomized trial. It included veterans whose health records could be linked to the study, a population with higher baseline health risks than the full COURAGE trial population. Researchers also noted that identifying heart attacks through routinely collected health records has limitations, although results were consistent with events independently verified during the original trial.

Ultimately, Butala said, the findings highlight why it's important to look beyond whether a procedure successfully opens an artery and ask whether it actually improves a patient's health over time. That distinction can help doctors and patients make more informed treatment decisions with the goal of helping patients live longer and avoid future heart attacks.

About the University of Colorado Anschutz
The University of Colorado Anschutz is a world-class academic medical campus leading transformative advances in science, medicine, education and patient care. The campus includes the University of Colorado's health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado - which see nearly three million adult and pediatric patient visits each year. Innovative, interconnected and highly collaborative, CU Anschutz delivers life-changing treatments, exceptional patient care and top-tier professional training. The campus conducts world-renowned research supported by $890 million in funding, including $762 million in sponsored awards and $128 million in philanthropic gifts for research.

Find the latest CU Anschutz news here.

Contact: Laura Kelley, CU Anschutz
(303) 704-5222, laura.kelley@cuanschutz.edu

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SOURCE University of Colorado Anschutz