Results for the Ischemia Trials: To Intervene or Not to Intervene

It is unknown whether a routine invasive approach of cardiac catheterization and revascularization offers incremental value over a conservative approach of optimal medical therapy (OMT), with catheterization reserved for failure of medical therapy in patients with stable ischemic heart disease (SIHD) and moderate or severe ischemia.
Results:
5179 participants were randomized. Participants were 64 years old (median), 23% women, 34% 1726 nonwhite, 16% Hispanic, 41% diabetic, and 90% with a history of angina. The qualifying stress test modality was stress imaging in 3909 (75%); the remainder were nonimaging ETTs. Core laboratories judged that the trial-required level of ischemia was met in 85% of randomized participants. Among the 3912 of 5179 randomized participants who underwent coronary computed tomography angiography, 79% had multivessel CAD and 87% had left anterior descending (LAD) stenosis (proximal in 47%). Primary and secondary clinical outcomes will be presented.

Conclusion:
ISCHEMIA will provide evidence regarding whether an invasive management strategy improves clinical outcomes when added to optimal medical therapy in patients with SIHD and moderate or severe ischemia.

Author(s)Source
Hochman JSAmerican Heart Association, Scientific Sessions, International Study of Comparative Health Effectiveness With Medical and Invasive Approaches: Primary Report of Clinical Outcomes, November 16, 2019
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