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Complete Revascularization and Angina-Related Health Status in the ISCHEMIA Trial

Kreton Mavromatis1, Philip G Jones2, Ziad A Ali3

  • 1Emory University, Atlanta VA Healthcare System, Atlanta, Georgia, USA.

Journal of the American College of Cardiology
|July 19, 2023
PubMed

Insights

Complete revascularization (CR) significantly improves health status in chronic coronary disease (CCD) patients, especially those with frequent angina. Both anatomic and functional CR offer comparable quality of life benefits compared to incomplete revascularization or conservative management.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Health Outcomes Research

Background:

  • The impact of complete revascularization (CR) on health status in chronic coronary disease (CCD) remains understudied.
  • Existing research lacks comprehensive data on CR's effect on symptoms, function, and quality of life.

Purpose of the Study:

  • To evaluate the impact of CR versus incomplete revascularization (ICR) on health status in CCD patients.
  • To compare the predicted impact of achieving CR in all invasive strategy patients versus conservative management.

Main Methods:

  • Analysis of data from the ISCHEMIA trial, comparing invasive (INV) versus conservative (CON) management.
  • Multivariable regression and propensity-weighted modeling to assess health status at 12 months post-intervention.
  • Independent core laboratory assessment of CR and incomplete revascularization (ICR).

Main Results:

  • Complete revascularization (CR) was achieved in 43.3% (anatomic) and 57.8% (functional) of invasive patients.
  • CR was associated with improved angina frequency compared to ICR.
  • Modeled CR and ICR in all invasive patients showed greater health status improvements than conservative management, with CR showing superior outcomes, particularly for patients with baseline frequent angina.

Conclusions:

  • Complete revascularization (CR) improves health status in chronic coronary disease (CCD) patients more than incomplete revascularization (ICR) or conservative (CON) management.
  • Benefits of CR are most significant in patients experiencing frequent angina.
  • Anatomic and functional CR yield comparable improvements in quality of life.
Abstract

Keywords:
complete revascularizationcoronary artery diseaseischemiaquality of liferevascularization

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