Interventions for stable coronary disease (chronic coronary syndromes)

ADDENDUM: ISCHEMIA Trial

Published on December 9, 2020

A report from Piera Capranzano, Rodney De Palma

The ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial aimed to compare an initial invasive strategy (angiography and revascularization when feasible) added to optimal medical therapy (OMT) versus an initial conservative strategy of OMT alone and angiography if medical therapy failed1. Patients with stable coronary disease were enrolled after clinically indicated stress testing showed moderate or severe reversible ischemia on imaging tests or severe ischemia on exercise tests without imaging.
Among 26,000 patients preliminary screened from stress test reports for potential eligibility based on level of ischemia, only 8518 were enrolled based on trial exclusion criteria (Figure). After undergoing blinded coronary computed tomography angiography to exclude patients with left main coronary artery disease, those without obstructive atherosclerosis or those with unfavorable anatomical factors, and after excluding patients for other reasons, 5179 (around 20%) patients were randomized to initial invasive or conservative strategy.

The initial invasive strategy provided greater improvement in angina-related health status but did not reduce the risk of ischemic cardiovascular events over a median of 3.2 years. However, a...