Medical Therapy vs. Invasive Strategy in Stable Ischemic Heart Disease

In the ISCHEMIA trial, an invasive approach offered no advantage in clinical outcomes but some improvement in angina.

In patients with stable coronary disease and moderate-to-severe ischemia, is invasive intervention plus optimal medical therapy better than medical therapy alone? Long-awaited peer-reviewed data from the randomized ISCHEMIA trial offer insights. Of the 5179 participants (in 37 countries), most underwent coronary CT angiography to exclude significant left-main and nonobstructive coronary disease. Median follow-up was 3.2 years.

The primary composite outcome — death from cardiovascular causes, myocardial infarction (MI), or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest — occurred in 318 patients in the invasive group and 352 in the conservative group. Cumulative incidence was significantly higher with the i…

Reviewing Author

Fatima Rodriguez, MD, MPH, FACC, FAHA

Disclosures

Consultant/Advisory BoardNovoNordisk; HealthPals; Novartis; Amgen

EquityHealthPals; Carta

Grant/Research SupportNational Institutes of Health/National Heart, Lung, and Blood Institute; American Heart Association–Robert Wood Johnson Foundation

Editorial BoardsCardiology and Therapy