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August 22/29, 2007

Off-Label Use of Drug-Eluting Stents

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(8):859-860. doi:10.1001/jama.298.8.859-a

To the Editor: Dr Beohar and colleagues1 studied the off-label use of drug-eluting stents for patients with coronary lesions. We note that the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial concluded that when percutaneous coronary intervention (PCI) was added to optimal medical therapy as an initial management strategy in patients with stable coronary artery disease (CAD), it did not reduce the risk of death, myocardial infarction, or other major cardiovascular events.2 It would be helpful to know what proportion of the 6993 patients in the registry studied by Beohar et al1 had stable CAD because the choices regarding PCI use in stable CAD are individualized among the cardiologists. Finally, given the decreased effectiveness with off-label use, we would like to know if statins, angiotensin-converting enzyme inhibitors, and β-blockers were frequently and similarly used in the off-label and standard use groups.