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Will ISCHEMIA change our daily practice?

David Meier1, Thabo Mahendiran1, Stephane Fournier1,2

  • 1Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.

Cardiovascular Diagnosis and Therapy
|September 24, 2020
PubMed
Summary
This summary is machine-generated.

The ISCHEMIA trial showed invasive strategies did not significantly reduce cardiovascular events in stable coronary artery disease (CAD). This study found most patients receiving percutaneous coronary interventions (PCIs) in a public hospital would have been excluded from the ISCHEMIA trial.

Keywords:
Stable coronary artery disease (CAD)optimal medical therapypercutaneous coronary intervention (PCI), ISCHEMIA

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • The ISCHEMIA trial demonstrated no significant benefit of an invasive strategy over medical therapy for stable coronary artery disease (CAD) with moderate to severe ischemia.
  • The trial's findings may influence clinical practice, but its applicability to diverse patient populations needs evaluation.

Purpose of the Study:

  • To evaluate the impact of the ISCHEMIA trial's exclusion criteria on the daily practice of percutaneous coronary interventions (PCIs) at a public university hospital.
  • To determine the proportion of patients undergoing PCI who would have been eligible for the ISCHEMIA trial.

Main Methods:

  • Retrospective analysis of 1,000 consecutive PCIs performed at a public university hospital.
  • Application of ISCHEMIA trial exclusion criteria to the analyzed patient cohort.
  • Sub-analysis focusing on patients with stable CAD.

Main Results:

  • Only 9.1% of all PCI patients met ISCHEMIA inclusion criteria, primarily due to high rates of acute coronary syndrome (ACS).
  • In patients with stable CAD, 71.6% undergoing PCI would have been excluded from the ISCHEMIA trial due to exclusion criteria.
  • The majority of PCIs were performed on patients who would not have met ISCHEMIA trial eligibility.

Conclusions:

  • Most percutaneous coronary interventions (PCIs) at this public university hospital are performed on patients who would be excluded from the ISCHEMIA trial.
  • The ISCHEMIA trial's direct impact on the real-world practice for PCI in this setting may be limited.
  • Clinical decisions for PCI in stable CAD patients at public hospitals may differ from ISCHEMIA trial parameters.