{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:42:19Z","timestamp":1774935739109,"version":"3.50.1"},"reference-count":46,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,7,5]],"date-time":"2013-07-05T00:00:00Z","timestamp":1372982400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To describe trends in the use of percutaneous coronary intervention (<jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content>) following the <jats:styled-content style=\"fixed-case\">COURAGE<\/jats:styled-content> trial, which found that medical therapy is as effective as <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content> for patients with stable angina.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>We used the National Hospital Discharge Survey; inpatient and outpatient discharge data from <jats:styled-content style=\"fixed-case\">F<\/jats:styled-content>lorida, <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>aryland, and <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ew <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>ersey; and the English Hospital Episode Statistics database.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We report trends in <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content> volume by diagnosis (stable angina vs. unstable angina or <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>) before and after publication of the <jats:styled-content style=\"fixed-case\">COURAGE<\/jats:styled-content> trial.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>The number of <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content>s in patients without a diagnosis of <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content> or unstable angina in <jats:styled-content style=\"fixed-case\">F<\/jats:styled-content>lorida, <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>aryland, and <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ew <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>ersey declined from 48,000 in 2006 to 40,000 in 2008 (\u221217 percent). There was no change in the number of <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content>s in patients with a diagnosis of <jats:styled-content style=\"fixed-case\">AMI<\/jats:styled-content>. We observed similar patterns in <jats:styled-content style=\"fixed-case\">U.S.<\/jats:styled-content> community hospitals. <jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content> volume did not decline in <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>ngland.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">PCI<\/jats:styled-content> volume declined after publication of the <jats:styled-content style=\"fixed-case\">COURAGE<\/jats:styled-content> trial. The experience of the <jats:styled-content style=\"fixed-case\">COURAGE<\/jats:styled-content> trial suggests that comparative effectiveness research can lead to cost\u2010saving changes in medical practice patterns. 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