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The ISCHEMIA trial: optimal medical therapy against PTCA in the stable patient: the endless story

Andrea Santucci1, Claudio Cavallini1

  • 1Azienda Ospedaliera S.Maria della Misericordia, Piazzale Menghini 1, 06129 Perugia, Italy.

European Heart Journal Supplements : Journal of the European Society of Cardiology
|October 15, 2021
PubMed

Insights

For stable coronary artery disease, revascularization offers no survival benefit over optimal medical therapy alone. Recent studies confirm that invasive procedures do not improve prognosis in these patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology

Background:

  • Coronary revascularization benefits acute coronary syndrome patients.
  • Prognostic impact of revascularization in stable coronary artery disease (CAD) remains debated.
  • Previous trials like COURAGE (2007) showed no significant benefit.

Purpose of the Study:

  • To evaluate the prognostic impact of coronary revascularization versus medical therapy in stable CAD.
  • To assess if an invasive strategy improves outcomes compared to a non-invasive approach.

Main Methods:

  • ISCHEMIA study (2020) compared selective coronary angiography and revascularization with a non-invasive strategy.
  • Patients with >50% coronary stenosis underwent initial computed axial tomography angiography.
  • Randomization to invasive (revascularization) or non-invasive (medical therapy, revascularization if destabilized) arms.

Main Results:

  • ISCHEMIA did not show superiority of revascularization over medical therapy for the primary composite endpoint.
  • The endpoint included cardiovascular death, acute myocardial infarction (AMI), or hospitalization for unstable angina, heart failure, or cardiac arrest.
  • Similar to COURAGE, no significant prognostic improvement was observed with revascularization.

Conclusions:

  • Coronary revascularization in stable CAD patients does not improve prognosis compared to optimal medical therapy alone.
  • Current evidence supports medical management as the primary strategy for stable coronary artery disease.
  • Invasive strategies are not superior for long-term outcomes in stable ischemic heart disease.

Keywords:
AnginaChronic coronary syndromeIschaemiaPCIRevascularizationStable coronary artery disease

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