The wisdom in ISCHEMIA.

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Clinical Trials

Background:

• Stable coronary artery disease (CAD) affects millions globally.
• Optimal treatment strategies for moderate-to-severe ischemia in stable CAD remain debated.
• The International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) trial aimed to resolve this.

Purpose of the Study:

• To compare the effectiveness of a routine invasive strategy versus optimal medical therapy (OMT) alone in patients with stable CAD and at least moderate ischemia.
• To evaluate the impact on major adverse cardiovascular events (MACE).

Main Methods:

• Randomized controlled trial involving patients with stable CAD and moderate-to-severe ischemia.
• Comparison between an invasive strategy (angiography followed by revascularization if indicated) plus OMT versus OMT alone.
• Follow-up duration of 3.3 years.

Main Results:

• No significant difference in MACE between the invasive strategy and OMT alone.
• Both groups received high-quality OMT.
• The invasive approach did not demonstrate superiority over OMT alone for the primary endpoint.

Conclusions:

• For patients with stable CAD and moderate-to-severe ischemia, a routine invasive approach is not superior to OMT alone.
• Trial findings necessitate careful consideration of individual patient factors and shared decision-making.
• Further discussion is warranted regarding the trial's applicability to diverse real-world clinical scenarios.