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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 -blockers were frequently and similarly used in the off-label and standard use groups.

Financial Disclosures: None reported.

Ravi K. Bobba, MD
rkbobba@gmail.com

Madhavi Bollu, MD
Salem Veterans Affairs Medical Center
Salem, Virginia

Edward L. Arsura, MD
New York Medical College (Richmond) Program
Richmond University Medical Center
Staten Island

1. Beohar N, Davidson CJ, Kip KE, et al. Outcomes and complications associated with off-label and untested use of drug-eluting stents. JAMA. 2007;297(18):1992-2000. FREE FULL TEXT 2. Boden WE, O’Rourke RA, Teo KK, et al. Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med. 2007;356(15):1503-1516. FREE FULL TEXT

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

JAMA. 2007;298(8):859.

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