In the ISCHEMIA trial, patients with stable coronary artery disease and moderate-to-severe ischaemia were randomized to routine invasive versus conservative management. What was the primary outcome finding?
- A Significant reduction in all-cause mortality with routine invasive strategy
- B Significant reduction in non-fatal MI with optimal medical therapy alone
- C No significant difference in the primary composite endpoint of cardiovascular death, MI, or hospitalization for unstable angina at median 3.2 years ✓
- D Invasive strategy significantly improved quality of life but increased stroke risk
Correct answer: C. No significant difference in the primary composite endpoint of cardiovascular death, MI, or hospitalization for unstable angina at median 3.2 years
Explanation
The ISCHEMIA trial (NEJM 2020) demonstrated no significant difference in the primary composite outcome (cardiovascular death, MI, hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest) between routine invasive versus optimal medical therapy alone in stable CAD with moderate-to-severe ischaemia. The invasive group had more procedural MIs early but fewer spontaneous MIs later. This landmark trial changed guidelines to support medical therapy as initial management for stable CAD patients without refractory symptoms.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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