Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when...

Area of Science:

• Cardiology
• Interventional Cardiology
• Clinical Trials

Background:

• Patients with acute coronary syndromes benefit from prompt revascularization alongside optimal medical therapy (OMT).
• However, for stable ischemic heart disease, evidence comparing OMT alone versus OMT plus revascularization has been inconclusive, showing similar outcomes.

Purpose of the Study:

• To synthesize findings from major randomized trials regarding the comparative effectiveness of OMT alone versus OMT plus revascularization in stable ischemic heart disease.
• To highlight the ongoing investigation into potential patient subsets who might benefit from revascularization.

Main Methods:

• Review and analysis of data from landmark randomized controlled trials including RITA-2, MASS II, COURAGE, BARI 2D, and FAME 2.
• Focus on outcomes such as mortality and myocardial infarction across diverse patient populations with varying atherosclerotic and ischemic burdens.

Main Results:

• Multiple trials demonstrate equipoise between OMT alone and OMT plus revascularization strategies in stable ischemic heart disease.
• No significant differences in mortality or myocardial infarction rates were observed between the two strategies in the studied populations.

Conclusions:

• Current evidence suggests that for most patients with stable ischemic heart disease, initial revascularization offers no significant advantage over OMT alone in terms of mortality and myocardial infarction.
• The ISCHEMIA trial is currently investigating specific patient subgroups within stable ischemic heart disease who may experience improved outcomes with revascularization.