In the ISCHEMIA trial (2019), patients with stable ischemic heart disease and moderate-to-severe ischemia on stress testing were randomized to an invasive strategy (early PCI/CABG) versus conservative medical therapy. The primary finding was:
- A No significant difference in cardiovascular death or MI between strategies over median follow-up ✓
- B Invasive strategy significantly reduced all-cause mortality
- C Invasive strategy reduced primary composite endpoint at 3.3 years follow-up
- D Conservative strategy was superior due to fewer periprocedural complications
Explanation
The ISCHEMIA trial found no significant difference in the primary composite outcome (cardiovascular death, MI, hospitalization for unstable angina, HF, or resuscitated cardiac arrest) between an initial invasive strategy and optimal medical therapy in patients with stable CAD and moderate-severe ischemia. Importantly, there was a higher rate of early periprocedural MI in the invasive group but fewer spontaneous MIs over follow-up. This trial reinforced the role of optimal medical therapy as the initial approach for stable ischemic heart disease, reserving invasive strategy for refractory symptoms.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.