Will ISCHEMIA change our daily practice?

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.