Placing a stent to widen narrowed coronary arteries, combined with medication, does not significantly reduce the long-term risk of myocardial infarction or death in patients with stable coronary artery disease. Researchers at the University of Colorado Anschutz School of Medicine reached this conclusion after analyzing patient follow-up data spanning 15–25 years.

The study results were published in JAMA and presented at the American Heart Association's Scientific Sessions in 2026.

In the original COURAGE clinical trial, researchers compared two approaches to treating stable coronary artery disease: percutaneous coronary intervention (PCI), or angioplasty, combined with optimal medical therapy, and medical therapy alone. During angioplasty, a physician widens a narrowed section of an artery using a small balloon and typically inserts a stent—a metal mesh tube that helps keep the blood vessel open.

In the new analysis, researchers examined data from 959 participants in the original trial, linking them to medical records. The median follow-up period was 15 years, with some patients followed for up to 25 years.

Over this period, no significant difference in the combined risk of death or heart attack was found between the two groups. The researchers estimated that by year 25, the cumulative incidence of these outcomes was 93.3% among patients initially assigned to angioplasty with stenting plus medical therapy, compared with 91% among those who received medication alone.

“When we open a blocked artery, we know that blood flow through it improves and symptoms ease. But the main question is whether this leads to a lower risk of heart attack or death in the long term,” explained the study's lead investigator, cardiologist Neel Butala.

The authors emphasize that the findings do not mean stenting is useless. The procedure can reduce chest pain and other symptoms of the disease, and emergency intervention for certain types of heart attack can save lives. The study addressed the initial treatment strategy for patients with stable coronary artery disease, not emergency care for acute coronary syndrome.

The study also has limitations. The analysis involved additional follow-up of participants in a previously conducted randomized trial, rather than a new randomized trial. It included 959 patients whose medical records could be linked, and veterans with elevated baseline health risks made up a substantial proportion of the original study population.