Survival After Invasive or Conservative Management of Stable Coronary Disease

Area of Science:

• Cardiology
• Clinical Trials
• Interventional Cardiology

Background:

• The ISCHEMIA trial investigated management strategies for chronic coronary disease with moderate to severe ischemia.
• Previous findings showed no significant differences in major outcomes between invasive and conservative approaches over 3.2 years.

Purpose of the Study:

• To report extended mortality follow-up data from the ISCHEMIA trial.
• To compare all-cause, cardiovascular, and noncardiovascular mortality between initial invasive and conservative strategies.

Main Methods:

• Randomized controlled trial comparing initial invasive vs. conservative strategies in 5179 patients.
• Extended follow-up for vital status through December 2021.
• Analysis using Cox regression and Bayesian methods, classifying undetermined deaths as cardiovascular.

Main Results:

• No significant difference in all-cause mortality at 7 years (12.7% invasive vs. 13.4% conservative).
• Lower 7-year cardiovascular mortality with invasive strategy (6.4% vs. 8.6%).
• Higher 7-year noncardiovascular mortality with invasive strategy (5.6% vs. 4.4%).

Conclusions:

• An initial invasive strategy does not alter overall mortality in chronic coronary disease patients.
• An invasive approach reduces cardiovascular mortality but increases non-cardiovascular mortality.
• No treatment effect heterogeneity observed in subgroups, including multivessel disease.