"Invasive Strategy vs. Conservative Strategy in Stable Coronary Disease and Moderate or Severe Ischemia".The New England Journal of Medicine. 2020.
Links to original sources: Wiki Journal Post Full Journal Article
Does an invasive strategy improve clinical outcomes compared to a conservative strategy in patients with stable coronary disease and moderate or severe ischemia?
Among patients with stable coronary disease and moderate or severe ischemia, an initial invasive strategy did not reduce the risk of ischemic cardiovascular events or death from any cause over a median of 3.2 years compared to a conservative strategy.
Previous studies have been inconclusive on whether revascularization, in addition to medical therapy, reduces the risk of death or myocardial infarction in patients with stable coronary artery disease. The ISCHEMIA trial addressed whether an invasive strategy, including angiography and revascularization, would be more beneficial than a conservative strategy of just medical therapy alone for patients with moderate or severe ischemia.
Not provided; the study assessed medical therapy compared to medical therapy plus revascularization in stable coronary disease with ischemia.
Multicenter, randomized, controlled trial with 5179 patients randomized to either an invasive strategy or conservative strategy.
Patients with stable coronary disease and moderate or severe ischemia on stress testing. Key exclusions included recent acute coronary syndrome, left main coronary artery disease, ejection fraction <35%, class III/IV heart failure, and severe symptoms despite medical therapy.
Invasive strategy (n=2588): medical therapy, angiography, and revascularization. Conservative strategy (n=2591): medical therapy alone, with angiography reserved for medical therapy failure.
Primary Outcome: - Composite of death from cardiovascular causes, myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. Secondary Outcomes: - Composite of death from cardiovascular causes or myocardial infarction. - Quality of life related to angina.
- Reduced power due to lower sample size and less than expected event rates. - Median follow-up of 3.2 years is relatively short. - Findings sensitive to the definition of myocardial infarction used. - Outcomes do not necessarily apply to patients with acute coronary syndromes, significant left main coronary artery disease, low ejection fraction, class III or IV heart failure, or those highly symptomatic on medical therapy.
Supported by grants from the National Heart, Lung, and Blood Institute, Arbor Pharmaceuticals, AstraZeneca Pharmaceuticals, and others.
- Not provided.