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Failed ISCHEMIA Trial or Failed Ischemia Testing?
Suraj Dahal, Matthew J Budoff1
1Professor of Medicine, UCLA School of Medicine, Program Director, Division of Cardiology, Director, Cardiac CT Laboratory, Lundquist Institute at Harbor-UCLA Medical Center, 1124 W. Carson Street, Torrance, CA 90502 USA. mbudoff@lundquist.org.
Insights
The ISCHEMIA trial found invasive therapy did not reduce major adverse cardiac events compared to optimal medical therapy for stable ischemic heart disease. Better revascularization guidance may improve outcomes in future studies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Stable ischemic heart disease (SIHD) affects millions globally.
- Optimal medical therapy (OMT) is the standard of care for SIHD.
- The role of invasive therapy in SIHD remains a subject of investigation.
Abstract:
The results of the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approach) trial were presented at the American Heart Association Scientific Sessions in November, 2019 in Philadelphia, Pennsylvania, and recently published on March 30, 2020 in the New England Journal of Medicine. After an average follow-up of 3.5 years, invasive therapy did not reduce the major adverse cardiac event (MACE) rate compared with optimal medical therapy (OMT) in patients with stable ischemic heart disease. However, the ISCHEMIA trial results might stem from the revascularization of inappropriate vessels and from the lack of a lesion-specific ischemia detection algorithm to guide revascularization instead of conventional stress testing. The utilization of an initial computed tomography (CT) angiogram with or without fractional flow reserve CT could have produced better revascularization results.
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