After ISCHEMIA: Is coronary CTA the new gatekeeper?

Area of Science:

• Cardiology
• Medical Imaging
• Clinical Trials

Background:

• Coronary artery disease (CAD) management focuses on symptom relief and prognosis.
• The ISCHEMIA trial evaluated an interventional strategy versus optimal medical therapy in stable CAD.

Purpose of the Study:

• To determine if routine invasive strategy improves outcomes in patients with moderate-to-severe ischemia and CAD.
• To assess the role of noninvasive cardiac imaging in diagnosing and managing CAD.

Main Methods:

• The ISCHEMIA trial randomized patients with stable ischemic heart disease to an invasive or conservative strategy.
• Coronary computed tomography (CT) angiography was used as a gatekeeper to randomization.

Main Results:

• The primary composite endpoint of death from cardiovascular causes or hospitalization for acute coronary syndrome was similar between strategies.
• Coronary CT angiography demonstrated potential as a diagnostic tool for suspected CAD.

Conclusions:

• A routine invasive strategy did not improve clinical outcomes compared to optimal medical therapy in patients with stable ischemic heart disease.
• Coronary CT angiography shows promise as a first- or second-line diagnostic tool for suspected CAD, warranting further investigation.